Provider Demographics
NPI:1932109667
Name:XINIM CORPORATION
Entity Type:Organization
Organization Name:XINIM CORPORATION
Other - Org Name:HOLLY HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:386-677-7377
Mailing Address - Street 1:1702 RIDGEWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5416
Mailing Address - Country:US
Mailing Address - Phone:386-677-7377
Mailing Address - Fax:386-677-0739
Practice Address - Street 1:1702 RIDGEWOOD AVE
Practice Address - Street 2:SUITE A - G
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-5416
Practice Address - Country:US
Practice Address - Phone:386-677-7377
Practice Address - Fax:386-677-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994706251E00000X
251F00000X, 261QI0500X
FLPH9050332B00000X, 332BP3500X, 332BX2000X
FLPH 9050333600000X
PH90503336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103813400Medicaid
FL0194100001Medicare NSC
FL101572900Medicare ID - Type UnspecifiedMEDICAID PHARMACY PROVIDE