Provider Demographics
NPI:1992263990
Name:COREHEALTH PHARMACY INC
Entity type:Organization
Organization Name:COREHEALTH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZENWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-450-8873
Mailing Address - Street 1:11260 PINES BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4101
Mailing Address - Country:US
Mailing Address - Phone:954-450-8873
Mailing Address - Fax:
Practice Address - Street 1:11260 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4101
Practice Address - Country:US
Practice Address - Phone:954-450-8873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005633400Medicaid