Provider Demographics
NPI:1306333497
Name:CARELINE PHARMACY AND HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:CARELINE PHARMACY AND HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAKYI
Authorized Official - Middle Name:KOBINA
Authorized Official - Last Name:SARSAH
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:813-333-0870
Mailing Address - Street 1:11200 E MARTIN LUTHER KING BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-8348
Mailing Address - Country:US
Mailing Address - Phone:813-333-0870
Mailing Address - Fax:813-235-4725
Practice Address - Street 1:11200 E MARTIN LUTHER KING BLVD
Practice Address - Street 2:STE 103
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3358
Practice Address - Country:US
Practice Address - Phone:813-333-0870
Practice Address - Fax:813-235-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH313323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177009OtherPK
FL025096400Medicaid