MEDICARE: IV STAT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	PH16174	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2011657	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669583092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IV STAT INC

Provider Business Mailing Address
First Line	:	533 EGLIN PKWY NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2829
Country	:	US
Telephone Number	:	850-226-8162
Fax Number	:	850-226-8485

Provider Business Practice Location Address
First Line	:	533 EGLIN PKWY NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2829
Country	:	US
Telephone Number	:	850-226-8162
Fax Number	:	850-226-8485

Authorized Official
Title or Position	:	PHCY MGR
Name	:	TRACY MCMORROW
Credential	:	PHARM D
Telephone Number	:	850-226-8162

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/11/2023

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