Provider Demographics
NPI:1598474017
Name:EXCEL PHARMACY PARTNERS LLC
Entity Type:Organization
Organization Name:EXCEL PHARMACY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-344-3691
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 2204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8200
Mailing Address - Country:US
Mailing Address - Phone:904-800-2285
Mailing Address - Fax:904-813-7905
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 2204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8200
Practice Address - Country:US
Practice Address - Phone:904-800-2285
Practice Address - Fax:904-813-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH31118OtherSTATE LICENSE
FL102482400Medicaid