Provider Demographics
NPI:1245275551
Name:CONTINUUMCARE PHARMACY LLC
Entity type:Organization
Organization Name:CONTINUUMCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7429
Mailing Address - Street 1:3802 CORPOREX PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1125
Mailing Address - Country:US
Mailing Address - Phone:813-318-6039
Mailing Address - Fax:
Practice Address - Street 1:78 PERRY WINKLE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-9506
Practice Address - Country:US
Practice Address - Phone:304-736-8310
Practice Address - Fax:304-736-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVMP05523853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016143Medicaid
5011666OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH2467665Medicaid
KY7100105610Medicaid