Healthcare Provider Details

I. General information

NPI: 1992786495
Provider Name (Legal Business Name): ACARIAHEALTH PHARMACY 13 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/21/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GARFIELD AVE
COMMERCE CA
90040
US

IV. Provider business mailing address

8517 SOUTHPARK CIR STE 200
ORLANDO FL
32819-9033
US

V. Phone/Fax

Practice location:
  • Phone: 323-262-9403
  • Fax: 866-834-8523
Mailing address:
  • Phone: 855-422-2742
  • Fax: 866-834-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN JENSEN
Title or Position: PRESIDENT
Credential:
Phone: 800-511-5144