Provider Demographics
NPI:1831322882
Name:PERSONAL ENRICHMENT THROUGH MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:PERSONAL ENRICHMENT THROUGH MENTAL HEALTH SERVICES
Other - Org Name:PEMHS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:877-813-2619
Mailing Address - Street 1:11254-58TH ST NORTH
Mailing Address - Street 2:BLDG D-PHARMACY
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782
Mailing Address - Country:US
Mailing Address - Phone:727-545-6477
Mailing Address - Fax:727-545-6472
Practice Address - Street 1:11254-58TH ST NORTH
Practice Address - Street 2:BLDG D-PHARMACY
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-545-6477
Practice Address - Fax:727-545-6472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL ENRICHMENT THROUGH MENTAL HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH13594251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1089879OtherNABP
FL0605ZZ101Medicaid