Provider Demographics
NPI:1568504496
Name:ACHI PHARM, INC
Entity Type:Organization
Organization Name:ACHI PHARM, INC
Other - Org Name:MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHAYA
Authorized Official - Middle Name:FIDELIS
Authorized Official - Last Name:ABUH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:863-224-7234
Mailing Address - Street 1:306 RUBY LAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3269
Mailing Address - Country:US
Mailing Address - Phone:863-224-7234
Mailing Address - Fax:
Practice Address - Street 1:301 HAVENDALE BLVD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4513
Practice Address - Country:US
Practice Address - Phone:863-967-3632
Practice Address - Fax:863-967-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH225933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1026815OtherNCPDP #
FLFA0319663OtherDEA #
FL5944660001Medicare NSC