Provider Demographics
NPI:1013296649
Name:INTERGRATED PHARMACEUTICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:INTERGRATED PHARMACEUTICAL SOLUTIONS LLC
Other - Org Name:BARTOW PHARMACY & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENOCH
Authorized Official - Middle Name:
Authorized Official - Last Name:OFOSU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MD
Authorized Official - Phone:863-537-6694
Mailing Address - Street 1:PO BOX 46216
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0102
Mailing Address - Country:US
Mailing Address - Phone:863-537-6694
Mailing Address - Fax:863-537-6579
Practice Address - Street 1:1478 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3373
Practice Address - Country:US
Practice Address - Phone:863-537-6694
Practice Address - Fax:863-537-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
FLPH254293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004112700Medicaid
FLPH25429OtherPHARMACY LICENSE