Provider Demographics
NPI:1598780082
Name:HUMANA MEDICAL PLAN INC
Entity Type:Organization
Organization Name:HUMANA MEDICAL PLAN INC
Other - Org Name:HUMANA PHARMACY 47908
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-970-2503
Mailing Address - Street 1:5643 NW 29TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5643 NW 29TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-1531
Practice Address - Country:US
Practice Address - Phone:954-970-2503
Practice Address - Fax:954-970-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH103143336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073941OtherOTHER ID NUMBER-COMMERCIAL NUMBER