Provider Demographics
NPI:1457423972
Name:PATIENT CARE PHARMACY SERVICES INC
Entity type:Organization
Organization Name:PATIENT CARE PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-255-1987
Mailing Address - Street 1:1476 MARKET CIR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-3876
Mailing Address - Country:US
Mailing Address - Phone:941-255-1987
Mailing Address - Fax:941-629-5507
Practice Address - Street 1:1476 MARKET CIR
Practice Address - Street 2:UNIT 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3876
Practice Address - Country:US
Practice Address - Phone:941-255-1987
Practice Address - Fax:941-629-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH174693336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022734000Medicaid
2013630OtherPK
5333270001Medicare NSC