Healthcare Provider Details

I. General information

NPI: 1598098204
Provider Name (Legal Business Name): USIPN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2009
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 W MACCLENNY AVE
MACCLENNY FL
32063-2033
US

IV. Provider business mailing address

391 W MACCLENNY AVE
MACCLENNY FL
32063-2033
US

V. Phone/Fax

Practice location:
  • Phone: 904-397-0440
  • Fax: 904-397-0441
Mailing address:
  • Phone: 904-397-0440
  • Fax: 904-397-0441

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 NumberPH24239
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANKUR PARIKH
Title or Position: PIC
Credential:
Phone: 904-397-0440