NPIViewer - Provider NPI 1992786495

NPI:	1992786495
Name:	ACARIAHEALTH PHARMACY 13 INC
Entity type:	Organization
Organization Name:	ACARIAHEALTH PHARMACY 13 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:	STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:	JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	800-511-5144
Mailing Address - Street 1:	8517 SOUTHPARK CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:	ORLANDO
Mailing Address - State:	FL
Mailing Address - Zip Code:	32819-9033
Mailing Address - Country:	US
Mailing Address - Phone:	855-422-2742
Mailing Address - Fax:	866-834-8523
Practice Address - Street 1:	3302 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:	COMMERCE
Practice Address - State:	CA
Practice Address - Zip Code:	90040
Practice Address - Country:	US
Practice Address - Phone:	323-262-9403
Practice Address - Fax:	866-834-8523
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2005-11-10
Last Update Date:	2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy
No	251F00000X	Agencies	Home Infusion

State	Identifier ID	ID Type	Issuer
IN	200925580A	Medicaid
ID	1992786495	Medicaid
AK	1028407	Medicaid
	2133836	Other	PK
FL	11979100	Medicaid
UT	1992786495	Medicaid
AZ	709279	Medicaid
CA	1992786495	Medicaid
HI	630914	Medicaid
MN	1992786495	Medicaid
MT	1992786495	Medicaid
OH	2947066	Medicaid
WA	6031785	Medicaid
OR	1992786495	Medicaid
UT	1992786495	Medicaid
IL	=========002	Medicaid