=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023024635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFUSION SYSTEMS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 03/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3890 TAMIAMI TRL STE C
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-8401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-629-7784
-----------------------------------------------------
Fax | 941-627-4369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3890 TAMIAMI TRL STE C
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-8401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-629-7784
-----------------------------------------------------
Fax | 941-627-4369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | JEFF STEELE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-629-4666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH13654
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------