Provider Demographics
NPI:1962799304
Name:PHARMA, LLC
Entity type:Organization
Organization Name:PHARMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-471-0007
Mailing Address - Street 1:3023 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1630
Mailing Address - Country:US
Mailing Address - Phone:863-471-0007
Mailing Address - Fax:863-588-4006
Practice Address - Street 1:3023 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1630
Practice Address - Country:US
Practice Address - Phone:863-471-0007
Practice Address - Fax:863-588-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24527332B00000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002114100Medicaid