Provider Demographics
NPI:1467761429
Name:SHARED PHARMACY HOLDINGS LLC
Entity Type:Organization
Organization Name:SHARED PHARMACY HOLDINGS LLC
Other - Org Name:SHARED PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-804-1836
Mailing Address - Street 1:6149 CHANCELLOR DR
Mailing Address - Street 2:SUITE 2780
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5680
Mailing Address - Country:US
Mailing Address - Phone:407-251-5492
Mailing Address - Fax:407-251-5392
Practice Address - Street 1:6149 CHANCELLOR DR STE 2780
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5680
Practice Address - Country:US
Practice Address - Phone:407-251-5492
Practice Address - Fax:407-251-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH248863336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701936OtherNCPDP PROVIDER IDENTIFICATION NUMBER