Healthcare Provider Details

I. General information

NPI: 1750580353
Provider Name (Legal Business Name): PICC LINES PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BUSINESS PARK WAY STE A-1
ROYAL PALM BEACH FL
33411-1756
US

IV. Provider business mailing address

300 BUSINESS PARK WAY STE A-1
ROYAL PALM BEACH FL
33411-1756
US

V. Phone/Fax

Practice location:
  • Phone: 561-736-5161
  • Fax: 561-736-7683
Mailing address:
  • Phone: 561-736-5161
  • Fax: 561-736-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPH23271
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN A LARIVIERE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 866-776-6782