Provider Demographics
NPI:1770687162
Name:CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
Entity Type:Organization
Organization Name:CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
Other - Org Name:WESTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO & CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7416
Mailing Address - Street 1:2950 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:954-659-6337
Mailing Address - Fax:954-659-6338
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:954-659-6337
Practice Address - Fax:954-659-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH213773336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0951400003Medicare NSC