Provider Demographics
NPI:1528654506
Name:PROSPER INFUSION, INC.
Entity type:Organization
Organization Name:PROSPER INFUSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:980-622-7124
Mailing Address - Street 1:12637 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1331
Mailing Address - Country:US
Mailing Address - Phone:813-749-0786
Mailing Address - Fax:
Practice Address - Street 1:12637 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:WESTCHASE
Practice Address - State:FL
Practice Address - Zip Code:33626-1331
Practice Address - Country:US
Practice Address - Phone:813-749-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy