Provider Demographics
NPI:1679623987
Name:CAREPLUS PHARMACY CORP
Entity Type:Organization
Organization Name:CAREPLUS PHARMACY CORP
Other - Org Name:CAREPLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POLUCARP
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBARA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:863-668-8480
Mailing Address - Street 1:3020 S COMBEE RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-7306
Mailing Address - Country:US
Mailing Address - Phone:863-668-8480
Mailing Address - Fax:860-668-8497
Practice Address - Street 1:3020 S COMBEE RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7306
Practice Address - Country:US
Practice Address - Phone:863-668-8480
Practice Address - Fax:860-668-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH222763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013944900Medicaid
2008286OtherPK
6021060001Medicare NSC
2008286OtherPK