=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770665556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFUSION TECHNOLOGIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 05/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3728 PHILLIPS HWY STE. 212
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-9300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-399-3332
-----------------------------------------------------
Fax | 904-399-3383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 NE 126TH ST
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-887-9335
-----------------------------------------------------
Fax | 305-883-8869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSE SOTOMAYOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-887-9335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number | PH20070
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------