Provider Demographics
NPI:1841692464
Name:ASC PHARMACY, INC.
Entity type:Organization
Organization Name:ASC PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ASCANIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-5411
Mailing Address - Street 1:3416 W 84TH ST
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4933
Mailing Address - Country:US
Mailing Address - Phone:305-698-5411
Mailing Address - Fax:395-698-5586
Practice Address - Street 1:3416 W 84TH ST
Practice Address - Street 2:SUITE 108A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4933
Practice Address - Country:US
Practice Address - Phone:305-698-5411
Practice Address - Fax:800-754-6602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASC PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH285803336H0001X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013516900Medicaid
FLFA0678269OtherDEA