Provider Demographics
NPI:1457729618
Name:VISTACARE PHARMACY SERVICES 2, LLC
Entity Type:Organization
Organization Name:VISTACARE PHARMACY SERVICES 2, LLC
Other - Org Name:VISTACARE PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-914-5227
Mailing Address - Street 1:7599 PARK BLVD N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2904
Mailing Address - Country:US
Mailing Address - Phone:727-914-5227
Mailing Address - Fax:727-914-5228
Practice Address - Street 1:7599 PARK BLVD N
Practice Address - Street 2:SUITE 100
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2904
Practice Address - Country:US
Practice Address - Phone:727-914-5227
Practice Address - Fax:727-914-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH290573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy