Provider Demographics
NPI:1972784841
Name:COMPLETE PHARMACY AND MEDICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:COMPLETE PHARMACY AND MEDICAL SOLUTIONS LLC
Other - Org Name:COMPLETE PHARMACY AND MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-697-5533
Mailing Address - Street 1:117 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1328
Mailing Address - Country:US
Mailing Address - Phone:217-697-5533
Mailing Address - Fax:800-830-1813
Practice Address - Street 1:5829 NW 158TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6721
Practice Address - Country:US
Practice Address - Phone:305-397-2035
Practice Address - Fax:866-454-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336M0003X, 3336S0011X
FLPH283393336C0003X
FLPH229933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011676OtherPK
2011676OtherPK