Provider Demographics
NPI:1215073820
Name:CDS PHARMACIES INC
Entity type:Organization
Organization Name:CDS PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM PHARM D RPH
Authorized Official - Phone:239-415-3309
Mailing Address - Street 1:10061 AMBERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8502
Mailing Address - Country:US
Mailing Address - Phone:239-415-3309
Mailing Address - Fax:239-433-5518
Practice Address - Street 1:10061 AMBERWOOD RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8502
Practice Address - Country:US
Practice Address - Phone:239-415-3309
Practice Address - Fax:239-433-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336M0002X
FLPH224873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1024380OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5972220001Medicare NSC