Provider Demographics
NPI:1598762015
Name:COMMCARE PHARMACY-FTL LLC
Entity Type:Organization
Organization Name:COMMCARE PHARMACY-FTL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RAFFALO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:954-284-2384
Mailing Address - Street 1:855 SW 78TH AVE
Mailing Address - Street 2:STE C100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-568-6212
Mailing Address - Fax:954-568-2765
Practice Address - Street 1:855 SW 78TH AVE
Practice Address - Street 2:STE C100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3223
Practice Address - Country:US
Practice Address - Phone:954-568-6212
Practice Address - Fax:954-568-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNRX0000870333600000X
IL054.016610333600000X
DEA9-0001012333600000X
IA3817333600000X
FLPH21660333600000X
IN64000929A333600000X
GAPHNR000479333600000X
CT897333600000X
KS22-44984333600000X
HIPMP591333600000X
CO5788333600000X
AZY005081333600000X
AK106493333600000X
CANRP1817333600000X
ID2293MS333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031179100Medicaid
FL691438100Medicaid
FL031179101Medicaid
2010319OtherPK
FL691438100Medicaid