Provider Demographics
NPI:1760017487
Name:BSN HEALTH
Entity Type:Organization
Organization Name:BSN HEALTH
Other - Org Name:FAMILY CARE CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARSI
Authorized Official - Middle Name:
Authorized Official - Last Name:HATAM POUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-866-9660
Mailing Address - Street 1:45665 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-4546
Mailing Address - Country:US
Mailing Address - Phone:863-866-9660
Mailing Address - Fax:863-353-1190
Practice Address - Street 1:45665 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-4546
Practice Address - Country:US
Practice Address - Phone:863-866-9660
Practice Address - Fax:863-353-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32608OtherBOARD OF PHARMACY LICENSE