MEDICARE: ACARIAHEALTH PHARMACY #11, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1215571625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACARIAHEALTH PHARMACY #11, INC.

Provider Business Mailing Address
First Line	:	8427 SOUTHPARK CIR STE 400
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-9057
Country	:	US
Telephone Number	:	855-422-2742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 W SAM HOUSTON PKWY N STE 130
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4015
Country	:	US
Telephone Number	:	832-900-1367
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN JENSEN
Credential	:
Telephone Number	:	800-511-5144

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	03/11/2020

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