Provider Demographics
NPI:1558635755
Name:INFUSION PRN LLC
Entity Type:Organization
Organization Name:INFUSION PRN LLC
Other - Org Name:INFUSION PRN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/COO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-747-8900
Mailing Address - Street 1:4953 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6296
Mailing Address - Country:US
Mailing Address - Phone:804-888-8630
Mailing Address - Fax:804-888-8628
Practice Address - Street 1:4953 COX RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6296
Practice Address - Country:US
Practice Address - Phone:804-888-8630
Practice Address - Fax:804-888-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VA02010044203336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4844076OtherNCPDP PROVIDER IDENTIFICATION NUMBER