Healthcare Provider Details

I. General information

NPI: 1164789608
Provider Name (Legal Business Name): FLORIDA INTEGRATED HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 W BAKER ST STE B
PLANT CITY FL
33563-1601
US

IV. Provider business mailing address

3202 W BAKER ST
PLANT CITY FL
33563-2849
US

V. Phone/Fax

Practice location:
  • Phone: 813-719-3278
  • Fax: 813-754-7540
Mailing address:
  • Phone: 813-704-6857
  • Fax: 813-756-6938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH22531
License Number StateFL

VIII. Authorized Official

Name: ABIOLA ADEYEMO
Title or Position: OWNER
Credential:
Phone: 813-719-3278