Provider Demographics
NPI:1639666985
Name:ENVISION PHARMACY AND HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ENVISION PHARMACY AND HEALTHCARE SERVICES LLC
Other - Org Name:ENVISION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-333-0750
Mailing Address - Street 1:18125 N US HIGHWAY 41 STE 107
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4498
Mailing Address - Country:US
Mailing Address - Phone:813-333-0750
Mailing Address - Fax:866-780-9023
Practice Address - Street 1:18125 N US HIGHWAY 41 STE 107
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4498
Practice Address - Country:US
Practice Address - Phone:813-333-0750
Practice Address - Fax:866-780-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-21
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH313363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112631900Medicaid
2177190OtherPK