Ebenezer Clinical Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH30718 Issued in FL

Legal business name

EBENEZER CLINICAL PHARMACY LLC

Practice address

4073 13TH St
Saint Cloud, FL 34769

Phone

(407) 891-9280

Fax

(407) 891-9200

NPI assigned

May 11, 2017

Organization subpart

No

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

Authorized official

Name

Tina Ihera

Title

Pharmacist/Owner

Phone

(407) 969-8130

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• EBENEZER CLINICAL PHARMACY Doing business as

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tina Ittera

  • Pharmacist
  • Saint Cloud, FL
  • NPI 1679409825
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1285161083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4073 13TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "34769",
            "telephone_number": "407-891-9280",
            "fax_number": "407-891-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4073 13TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "34769",
            "telephone_number": "407-891-9280",
            "fax_number": "407-891-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER CLINICAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "IHERA",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "407-969-8130"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH30718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2171741",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EBENEZER CLINICAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.