Provider Demographics
NPI:1932145497
Name:PROXYCARE INC
Entity Type:Organization
Organization Name:PROXYCARE INC
Other - Org Name:PROXYCARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-791-5400
Mailing Address - Street 1:747 SHOTGUN ROAD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1934
Mailing Address - Country:US
Mailing Address - Phone:954-791-5400
Mailing Address - Fax:954-791-5100
Practice Address - Street 1:747 SHOTGUN ROAD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1934
Practice Address - Country:US
Practice Address - Phone:954-791-5400
Practice Address - Fax:954-791-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH129463336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022228300Medicaid
2011819OtherPK
2011819OtherPK