Provider Demographics
NPI:1548371610
Name:ENCLARA PHARMACIA, INC.
Entity type:Organization
Organization Name:ENCLARA PHARMACIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-996-1187
Mailing Address - Street 1:2525 HORIZON LAKE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8119
Mailing Address - Country:US
Mailing Address - Phone:901-248-3700
Mailing Address - Fax:901-248-3703
Practice Address - Street 1:2525 HORIZON LAKE DR STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8119
Practice Address - Country:US
Practice Address - Phone:901-248-3700
Practice Address - Fax:901-248-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000037453336M0002X
3336L0003X
NHNR02303336L0003X
NE3553336L0003X
OK99-5923336L0003X
ARX014903336L0003X
AK6843336L0003X
WY44-381343336L0003X
KYTN8023336L0003X
ND5563336L0003X
CTPCN.00005533336L0003X
SD400-05393336L0003X
WVMO05595413336L0003X
TX0220013336L0003X
IL3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149650OtherPK