Healthcare Provider Details

I. General information

NPI: 1073733408
Provider Name (Legal Business Name): ACARIAHEALTH PHARMACY #26, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/09/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 HENDERSON RD
TAMPA FL
33634-1143
US

IV. Provider business mailing address

8715 HENDERSON RD
TAMPA FL
33634-1143
US

V. Phone/Fax

Practice location:
  • Phone: 866-458-9246
  • Fax: 866-458-9245
Mailing address:
  • Phone: 866-458-9246
  • Fax: 886-458-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22669
License Number StateFL

VIII. Authorized Official

Name: JESSICA DAWN CICCOLELLA-KAHL
Title or Position: PRESIDENT
Credential:
Phone: 855-422-2742