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General NPI Number Information
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NPI Number | 1942203187
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Entity Type | Organization
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Legal Business Name | AETNA SPECIALTY PHARMACY, LLC
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 503 SUNPORT LANE
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City | ORLANDO
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State | FL
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Zip | 32809-7874
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Country | US
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Telephone | 407-513-6400
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Fax | 866-329-2779
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Provider Business Mailing Address
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Address Line | 503 SUNPORT LANE
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City | ORLANDO
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State | FL
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Zip | 32809-7874
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Country | US
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Telephone | 407-513-6400
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Fax | 866-329-2779
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Authorized Official
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Title or Position | SR. PHARMACY OPS MGR
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Name | JEAN R. CARNEY
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Credential |
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Telephone | 407-513-6495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PH21035
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH21035
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License Number State | FL
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