Healthcare Provider Details

I. General information

NPI: 1912016940
Provider Name (Legal Business Name): ACARIAHEALTH PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 ARLINGTON BLVD SUITE 110
FAIRFAX VA
22031-4621
US

IV. Provider business mailing address

6923 LEE VISTA BLVD., SUITE 300
ORLANDO FL
32822-4701
US

V. Phone/Fax

Practice location:
  • Phone: 703-846-9912
  • Fax: 703-846-4998
Mailing address:
  • Phone: 407-903-1308
  • Fax: 407-903-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN D. JENSEN
Title or Position: CFO
Credential:
Phone: 407-903-1335