Provider Demographics
NPI:1407468580
Name:INTRACARE HEALTH SERVICES
Entity Type:Organization
Organization Name:INTRACARE HEALTH SERVICES
Other - Org Name:PHARMACON, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:888-327-2233
Mailing Address - Street 1:160 SW 12TH AVE STE 101D
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3114
Mailing Address - Country:US
Mailing Address - Phone:888-327-2233
Mailing Address - Fax:888-439-4453
Practice Address - Street 1:160 SW 12TH AVE STE 101D
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3114
Practice Address - Country:US
Practice Address - Phone:888-327-2233
Practice Address - Fax:888-439-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral NutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS19129OtherFLORIDA BOARD OF PHARMACY