MEDICARE: AETNA SPECIALTY PHARMACY, LLC

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	3336H0001X	Home Infusion Therapy Pharmacy	PH21035	FL
2	3336S0011X	Specialty Pharmacy	PH21035	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1714655	OTHER	AETNA HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	3726379	OTHER	AETNA HEALTHCARE HMO CLMS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7446672	OTHER	AETNA HEALTHCARE DIEM CLAIM
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	3726379	OTHER	AETNA HEALTHCARE HMO CLAIMS
14	7446672	OTHER	AETNA HEALTHCARE DIEM CLM
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
26	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942203187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AETNA SPECIALTY PHARMACY, LLC

Provider Business Mailing Address
First Line	:	503 SUNPORT LANE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7874
Country	:	US
Telephone Number	:	407-513-6400
Fax Number	:	866-329-2779

Provider Business Practice Location Address
First Line	:	503 SUNPORT LANE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7874
Country	:	US
Telephone Number	:	407-513-6400
Fax Number	:	866-329-2779

Authorized Official
Title or Position	:	SR. PHARMACY OPS MGR
Name	:	JEAN R. CARNEY
Credential	:
Telephone Number	:	407-513-6495

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/19/2014

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MEDICARE: AETNA SPECIALTY PHARMACY, LLC

Scope of Practice

Other Identifiers

General Provider Information

Similar Medicare Providers

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