NPIMap

Organization Active NPI

Executive Health, LLC

  • Pharmacy
  • Fort Myers, FL
National Provider Identifier
1578719290
Registry record updated Aug 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
13749 Issued in FL
Legal business name
EXECUTIVE HEALTH, LLC
Practice address
2675 Winkler Ave
Fort Myers, FL 33901-9342
Phone
(239) 939-3949
Fax
(239) 939-5866
NPI assigned
Aug 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2008

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

Authorized official

Name
Mr. Semyon Narosov, MSPT
Title
President
Phone
(972) 702-9310

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 13749 FL Primary

Addresses

Primary practice location

2675 Winkler Ave
Fort Myers, FL 33901-9342

Mailing address

19009 Preston Rd Ste 215-106
Dallas, TX 75252-2496
Phone (972) 702-9310

Other names 1

  • Harrington's Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Allied Tri-Med4 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.

Locations

19009 Preston Rd
Ste 215106
Dallas, TX 75252

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219276800000",
    "number": "1578719290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19009 PRESTON RD STE 215-106",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752522496",
            "telephone_number": "972-702-9310",
            "fax_number": "972-458-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "239-939-3949",
            "fax_number": "239-939-5866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-08-21",
        "status": "A",
        "authorized_official_last_name": "NAROSOV",
        "authorized_official_first_name": "SEMYON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-702-9310",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "13749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harrington's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; 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.