Provider Demographics
NPI:1366889362
Name:CARDINAL HEALTH PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:CARDINAL HEALTH PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, MANAGED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-749-4764
Mailing Address - Street 1:13651 DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4317
Mailing Address - Country:US
Mailing Address - Phone:281-749-4000
Mailing Address - Fax:
Practice Address - Street 1:27680 AVENUE MENTRY STE 100
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1452
Practice Address - Country:US
Practice Address - Phone:661-295-7124
Practice Address - Fax:661-295-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA9-00014473336C0003X
AK14653336C0003X, 3336C0003X
LAPHY.007207-NR3336C0003X, 3336C0003X
DCNRX00002753336C0003X
NJ28RO000975003336C0003X, 3336C0003X
OHNRP0223394003336C0003X
VA02140016053336C0003X
WAPHNR.FO.604097513336C0003X
NY0321563336C0003X
3336C0003X
CA511913336M0002X
NMPH000035983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140566OtherPK