Provider Demographics
NPI:1992386668
Name:FUSION FLOW PHARMACY, LLC
Entity Type:Organization
Organization Name:FUSION FLOW PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ACEVEDO-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:787-980-6770
Mailing Address - Street 1:15209 CRESTVIEW CV
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5602
Mailing Address - Country:US
Mailing Address - Phone:205-789-4507
Mailing Address - Fax:
Practice Address - Street 1:6655 TRAVIS ST STE 830
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1312
Practice Address - Country:US
Practice Address - Phone:787-980-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy