NPIMap

Organization Active NPI

Healthdyne Pharmacy FL, LLC

  • Mail Order Pharmacy
  • Lakeland, FL
National Provider Identifier
1093974982
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mail Order PharmacyTaxonomy code 3336M0002X
License
PH23389 Issued in FL
Legal business name
HEALTHDYNE PHARMACY FL, LLC
Practice address
500 Eagles Landing Dr
Lakeland, FL 33810-2899
Phone
(888) 479-2000
Fax
(863) 686-5682
NPI assigned
Jun 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Phillip P Bisesi
Title
Senior Vice President&Secretary
Phone
(863) 583-6248

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Mail Order Pharmacy 3336M0002X PH23389 FL Primary

Addresses

Primary practice location

500 Eagles Landing Dr
Lakeland, FL 33810-2899

Mailing address

500 Eagles Landing Dr
Lakeland, FL 33810-2899
Phone (888) 479-2000

Other identifiers 15

IdentifierTypeStateIssuer
2011832OtherPK
20200323899433MedicaidMI
001055000MedicaidFL
1017697MedicaidVT
1093974982MedicaidMN
20029370AMedicaidOK
9000170493MedicaidCO
032852900MedicaidMD
1093974982MedicaidWA
0205365MedicaidIA
200636740AMedicaidKS
100080584MedicaidWI
1024462370001MedicaidPA
1093974982MedicaidID
200972230AMedicaidIN

Other names 2

  • HealthDyne Pharmacy Doing business as
  • WELLDYNERX-FL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181005001380 FL Part B Supplier - Pharmacy 9133327729 Practice locations: Lakeland, FL

National Provider Directory

National Provider Directory
Tax ID family
Healthdyne Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7472 S Tucson Way
#100A
Centennial, CO 80112
Phone (888) 479-2000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1093974982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 EAGLES LANDING DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338102899",
            "telephone_number": "888-479-2000",
            "fax_number": "863-686-4710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 EAGLES LANDING DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338102899",
            "telephone_number": "888-479-2000",
            "fax_number": "863-686-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHDYNE PHARMACY FL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2025-08-12",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "BISESI",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT&SECRETARY",
        "authorized_official_telephone_number": "863-583-6248"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "FL",
            "license": "PH23389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2011832",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20200323899433",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001055000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017697",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093974982",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20029370A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000170493",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032852900",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093974982",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0205365",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200636740A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080584",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024462370001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093974982",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200972230A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthDyne Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WELLDYNERX-FL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.