Basic Information
| Provider Information | |||||||||
| NPI: | 1790234862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERITA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6912 S QUENTIN ST STE 50 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801124531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202825411 | ||||||||
| FaxNumber: | 8773025251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 HEMINGWAY DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029152224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014319020 | ||||||||
| FaxNumber: | 4014342026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2016 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRIYE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7202822377 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHARMACY CORPORATION OF AMERICA | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HNC02401 | RI | N | Agencies | Home Health | 332B00000X | PHA00611 | RI | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | PHA00611 | RI | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 3336S0011X | PHA00611 | RI | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336H0001X | PHA00611 | RI | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | FA6321107 | 01 | RI | DRUG ENFORCEMENT AGENCY | OTHER | 4107834 | 01 | NCPDP | OTHER | PHA00611 | 01 | RI | BOARD OF PHARMACY | OTHER |