Provider Demographics
NPI:1790106581
Name:SIMALI HEALTHCARE LLC
Entity Type:Organization
Organization Name:SIMALI HEALTHCARE LLC
Other - Org Name:OVIEDO PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAHMBHATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-459-4162
Mailing Address - Street 1:310 W MITCHELL HAMMOCK RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4924
Mailing Address - Country:US
Mailing Address - Phone:407-366-2677
Mailing Address - Fax:407-366-2535
Practice Address - Street 1:310 W MITCHELL HAMMOCK RD
Practice Address - Street 2:SUITE # 500
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4924
Practice Address - Country:US
Practice Address - Phone:407-366-2677
Practice Address - Fax:407-366-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH269463336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023048500Medicaid
2141873OtherPK