Provider Demographics
NPI:1588799001
Name:CADUCEUS PHARMACY II LLC
Entity Type:Organization
Organization Name:CADUCEUS PHARMACY II LLC
Other - Org Name:CADUCEUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/PHARMACIST IN CHARG
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:954-797-8077
Mailing Address - Street 1:4361 N. STATE RD. 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-797-8077
Mailing Address - Fax:954-797-8099
Practice Address - Street 1:4361 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4856
Practice Address - Country:US
Practice Address - Phone:954-797-8077
Practice Address - Fax:954-797-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH222993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004321OtherPK
FL031659800Medicaid
5950180001Medicare NSC