Provider Demographics
NPI:1912016940
Name:ACARIAHEALTH PHARMACY, INC.
Entity Type:Organization
Organization Name:ACARIAHEALTH PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-903-1335
Mailing Address - Street 1:6923 LEE VISTA BLVD., SUITE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4701
Mailing Address - Country:US
Mailing Address - Phone:407-903-1308
Mailing Address - Fax:407-903-1323
Practice Address - Street 1:8505 ARLINGTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-846-9912
Practice Address - Fax:703-846-4998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACARIAHEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral NutritionGroup - Single Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034613100Medicaid
VA1912016940Medicaid
SC7N3823Medicaid
MD401564900Medicaid
SC7N3823Medicaid