Provider Demographics
NPI:1790757508
Name:SOUTHWEST FLORIDA INFUSION CARE INC
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA INFUSION CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MERDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIEIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:561-876-4043
Mailing Address - Street 1:3340 FAIRLANE FARMS RD
Mailing Address - Street 2:STE 4
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-469-1181
Mailing Address - Fax:561-469-1182
Practice Address - Street 1:3340 FAIRLANE FARMS RD.
Practice Address - Street 2:STE 4
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-469-1181
Practice Address - Fax:561-469-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105405801Medicaid
FL105405800Medicaid
FL105405800Medicaid