Healthcare Provider Details

I. General information

NPI: 1013226687
Provider Name (Legal Business Name): LIFE SAVERX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E ROBERTSON ST STE B
BRANDON FL
33511-5254
US

IV. Provider business mailing address

207 E ROBERTSON ST SUITE B
BRANDON FL
33511-5254
US

V. Phone/Fax

Practice location:
  • Phone: 813-283-1131
  • Fax: 813-489-1789
Mailing address:
  • Phone: 813-283-1131
  • Fax: 813-489-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPH24913
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL CACERES
Title or Position: CEO/OWNER
Credential:
Phone: 813-283-1131