Provider Demographics
NPI:1912145715
Name:FLORIDA INTEGRATED HEALTH SERVICES
Entity Type:Organization
Organization Name:FLORIDA INTEGRATED HEALTH SERVICES
Other - Org Name:FAST & FRIENDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-704-6857
Mailing Address - Street 1:3202 W BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2849
Mailing Address - Country:US
Mailing Address - Phone:813-704-6857
Mailing Address - Fax:813-756-6938
Practice Address - Street 1:601 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-5516
Practice Address - Country:US
Practice Address - Phone:863-946-0006
Practice Address - Fax:863-946-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH238263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119639OtherPK
FL001276300Medicaid