Provider Demographics
NPI:1629525530
Name:INTEGRA NETWORK CORP
Entity Type:Organization
Organization Name:INTEGRA NETWORK CORP
Other - Org Name:INTEGRA RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZARINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-917-6813
Mailing Address - Street 1:2661 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2507
Mailing Address - Country:US
Mailing Address - Phone:954-917-6813
Mailing Address - Fax:954-917-6814
Practice Address - Street 1:2661 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2507
Practice Address - Country:US
Practice Address - Phone:954-917-6813
Practice Address - Fax:954-917-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH241833336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001560800Medicaid
2164045OtherPK