NPIMap

Organization Active NPI

Prime Therapeutics Pharmacy LLC

  • Mail Order Pharmacy
  • Orlando, FL
National Provider Identifier
1558738864
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mail Order PharmacyTaxonomy code 3336M0002X
License
PH19541 Issued in FL
Legal business name
PRIME THERAPEUTICS PHARMACY LLC
Practice address
6870 Shadowridge Dr Ste 111
Orlando, FL 32812-9002
Phone
(866) 554-2673
Fax
(866) 364-2673
NPI assigned
Aug 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Authorized official

Name
Andrew Glover
Title
VP & GM Specialty Pharmacy Dist
Phone
(612) 777-4940

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Mail Order Pharmacy 3336M0002X PH19541 FL Primary

Addresses

Primary practice location

6870 Shadowridge Dr Ste 111
Orlando, FL 32812-9002

Mailing address

6870 Shadowridge Dr
Ste 111
Orlando, FL 32812-9002
Phone (866) 554-2673

Other identifiers 27

IdentifierTypeStateIssuer
1245241884MedicaidVT
1245241884MedicaidOH
1245241884MedicaidID
30708673MedicaidNH
101323804-0002MedicaidPA
200855460AMedicaidIN
415778800MedicaidMD
589259MedicaidAZ
ATN66122MedicaidCO
1245241884MedicaidWI
1612421MedicaidAK
1245241884MedicaidMI
54012687MedicaidKY
7F9541MedicaidSC
031904000MedicaidFL
1245241884MedicaidME
513347297001MedicaidIL
1245241884MedicaidWA
1245241884MedicaidCT
1528692MedicaidTN
200412310AMedicaidOK
2153807OtherPK
538884MedicaidNJ
1245241884MedicaidMN
100265185-00MedicaidNE
1245241884MedicaidVA
600200927MedicaidMO

Other names 1

  • Magellan Rx Pharmacy Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Magellan RX Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1558738864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6870 SHADOWRIDGE DR",
            "address_2": "STE 111",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328129002",
            "telephone_number": "866-554-2673",
            "fax_number": "866-364-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6870 SHADOWRIDGE DR STE 111",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328129002",
            "telephone_number": "866-554-2673",
            "fax_number": "866-364-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME THERAPEUTICS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-24",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "VP & GM SPECIALTY PHARMACY DIST",
        "authorized_official_telephone_number": "612-777-4940"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "FL",
            "license": "PH19541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30708673",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101323804-0002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200855460A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415778800",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589259",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ATN66122",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1612421",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54012687",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7F9541",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031904000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "513347297001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528692",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200412310A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153807",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "538884",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100265185-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245241884",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600200927",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magellan Rx Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.