Provider Demographics
NPI:1659915965
Name:ACARIAHEALTH PHARMACY 12 INC
Entity Type:Organization
Organization Name:ACARIAHEALTH PHARMACY 12 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-511-5144
Mailing Address - Street 1:8427 SOUTHPARK CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9057
Mailing Address - Country:US
Mailing Address - Phone:855-422-2742
Mailing Address - Fax:877-801-6091
Practice Address - Street 1:5 SKYLINE DR STE 240
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2166
Practice Address - Country:US
Practice Address - Phone:800-511-5144
Practice Address - Fax:877-541-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy