Healthcare Provider Details

I. General information

NPI: 1619214616
Provider Name (Legal Business Name): CINERGY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 S ORANGE AVE SUITE B
ORLANDO FL
32806-3055
US

IV. Provider business mailing address

2116 S ORANGE AVE SUITE B
ORLANDO FL
32806-3055
US

V. Phone/Fax

Practice location:
  • Phone: 407-757-0567
  • Fax: 855-274-0569
Mailing address:
  • Phone: 407-757-0567
  • Fax: 855-274-0569

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 NumberNP000008
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26616
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TASHIMA KENNY
Title or Position: MANAGER
Credential:
Phone: 407-757-0567