Provider Demographics
NPI:1467884031
Name:MEDICURE LONGWOOD INC
Entity Type:Organization
Organization Name:MEDICURE LONGWOOD INC
Other - Org Name:MEDICURE LONGWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, AO
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-434-0433
Mailing Address - Street 1:420 W STATE ROAD 434
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5159
Mailing Address - Country:US
Mailing Address - Phone:407-434-0433
Mailing Address - Fax:407-910-2184
Practice Address - Street 1:420 W STATE ROAD 434 STE 100
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5159
Practice Address - Country:US
Practice Address - Phone:407-434-0433
Practice Address - Fax:407-910-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH269883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015528500Medicaid
2141563OtherPK