Healthcare Provider Details

I. General information

NPI: 1760024905
Provider Name (Legal Business Name): HIYACARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E VAN FLEET DR
BARTOW FL
33830-7626
US

IV. Provider business mailing address

1140 E VAN FLEET DR
BARTOW FL
33830-7626
US

V. Phone/Fax

Practice location:
  • Phone: 863-537-6910
  • Fax:
Mailing address:
  • Phone: 863-537-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. NARESH G PRAJAPATI
Title or Position: PHARMACIST
Credential:
Phone: 551-556-7305