Basic Information
Provider Information | |||||||||
NPI: | 1336544741 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CIRCLES OF CARE INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 400 SHERIDAN RD | ||||||||
Address2: |   | ||||||||
City: | MELBOURNE | ||||||||
State: | FL | ||||||||
PostalCode: | 329013122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3217225200 | ||||||||
FaxNumber: | 3219537576 | ||||||||
Practice Location | |||||||||
Address1: | 400 SHERIDAN RD | ||||||||
Address2: |   | ||||||||
City: | MELBOURNE | ||||||||
State: | FL | ||||||||
PostalCode: | 329013122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3217225200 | ||||||||
FaxNumber: | 3219537576 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/28/2014 | ||||||||
LastUpdateDate: | 10/28/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CAETANO | ||||||||
AuthorizedOfficialFirstName: | ALAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | IN PATIENT PHARMACY DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3217262856 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | PHARM. D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | PH17013 | FL | Y |   | Suppliers | Pharmacy |   |
ID Information
ID | Type | State | Issuer | Description | 1088194 | 01 | FL | NAPB | OTHER | PH17013 | 01 | FL | STATE LICENSE | OTHER |