Provider Demographics
NPI:1154750479
Name:EN-VISION HEALTH SERVICES LLC
Entity type:Organization
Organization Name:EN-VISION HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MADHUMATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-784-5590
Mailing Address - Street 1:11349 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7183
Mailing Address - Country:US
Mailing Address - Phone:813-672-8889
Mailing Address - Fax:
Practice Address - Street 1:11349 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7183
Practice Address - Country:US
Practice Address - Phone:813-672-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH27174333600000X, 3336C0003X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH27174OtherSTATE LICENSE