Healthcare Provider Details

I. General information

NPI: 1962172213
Provider Name (Legal Business Name): RECHARGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 SW 17TH ST STE B
OCALA FL
34471-8104
US

IV. Provider business mailing address

47 SW 17TH ST STE B
OCALA FL
34471-8104
US

V. Phone/Fax

Practice location:
  • Phone: 352-512-9996
  • Fax: 866-622-5714
Mailing address:
  • Phone: 352-512-9996
  • Fax: 866-622-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN JONES
Title or Position: PIC
Credential:
Phone: 352-512-9996