Provider Demographics
NPI:1124177951
Name:CIRCLES OF CARE INC
Entity type:Organization
Organization Name:CIRCLES OF CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACIES
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:321-914-4815
Mailing Address - Street 1:2020 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-2335
Mailing Address - Country:US
Mailing Address - Phone:321-952-6020
Mailing Address - Fax:321-952-6037
Practice Address - Street 1:2020 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2335
Practice Address - Country:US
Practice Address - Phone:321-952-6020
Practice Address - Fax:321-952-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH13653333600000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103354900Medicaid
FL103354900Medicaid