Provider Demographics
NPI:1396073607
Name:INFUPHARMA
Entity type:Organization
Organization Name:INFUPHARMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-210-6580
Mailing Address - Street 1:2013 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2714
Mailing Address - Country:US
Mailing Address - Phone:954-923-3839
Mailing Address - Fax:954-391-6154
Practice Address - Street 1:2013 HARDING ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2714
Practice Address - Country:US
Practice Address - Phone:954-923-3839
Practice Address - Fax:954-391-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000353600Medicaid
FL000353601Medicaid
2122880OtherPK
6218900001Medicare NSC