Provider Demographics
NPI:1881190759
Name:ASIAN SENIOR HOME CARE, INC
Entity Type:Organization
Organization Name:ASIAN SENIOR HOME CARE, INC
Other - Org Name:BLUEBIRD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-600-4099
Mailing Address - Street 1:145 HILDEN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8401
Mailing Address - Country:US
Mailing Address - Phone:904-600-4099
Mailing Address - Fax:904-484-7919
Practice Address - Street 1:145 HILDEN RD STE 102
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8401
Practice Address - Country:US
Practice Address - Phone:904-600-4099
Practice Address - Fax:904-484-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-31
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FL312573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176414OtherPK