Provider Demographics
NPI:1669583092
Name:IV STAT INC
Entity type:Organization
Organization Name:IV STAT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHCY MGR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMORROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:850-226-8162
Mailing Address - Street 1:533 EGLIN PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2829
Mailing Address - Country:US
Mailing Address - Phone:850-226-8162
Mailing Address - Fax:850-226-8485
Practice Address - Street 1:533 EGLIN PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2829
Practice Address - Country:US
Practice Address - Phone:850-226-8162
Practice Address - Fax:850-226-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH161743336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011657OtherPK
AL100020028Medicaid
FL106516500Medicaid