Provider Demographics
NPI:1417238684
Name:HOLLYWOOD HEALTHCARE CORP
Entity type:Organization
Organization Name:HOLLYWOOD HEALTHCARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-349-9551
Mailing Address - Street 1:15851 SW 41ST ST
Mailing Address - Street 2:#700
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1541
Mailing Address - Country:US
Mailing Address - Phone:954-349-9551
Mailing Address - Fax:954-349-9552
Practice Address - Street 1:15851 SW 41ST ST STE 700
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-1540
Practice Address - Country:US
Practice Address - Phone:954-349-9551
Practice Address - Fax:954-349-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000820400Medicaid
5707293OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL000820400Medicaid