NPIMap

Organization Active NPI

Life Specialty Pharmacy Medical Equipment and Supplies Inc.

  • Pharmacy
  • Orlando, FL
National Provider Identifier
1659441624
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PH 22346 Issued in FL
Legal business name
LIFE SPECIALTY PHARMACY MEDICAL EQUIPMENT AND SUPPLIES INC.
Practice address
1507 Park Center Drive
Suite 1K
Orlando, FL 32835-5795
Phone
(407) 405-0735
Fax
(407) 522-5684
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

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

Authorized official

Name
Michael Ayotunde
Title
President Owner
Phone
(407) 522-5683

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PH 22346 FL Primary
Clinic Pharmacy 3336C0002X PH 22346 FL
Compounding Pharmacy 3336C0004X PH 22346 FL
Home Infusion Therapy Pharmacy 3336H0001X PH 22346 FL
Institutional Pharmacy 3336I0012X PH 22346 FL
Long Term Care Pharmacy 3336L0003X PH 22346 FL
Mail Order Pharmacy 3336M0002X PH 22346 FL

Addresses

Primary practice location

1507 Park Center Drive
Suite 1K
Orlando, FL 32835-5795

Mailing address

1507 Park Center Drive
Suite 1K
Orlando, FL 32835-5795
Phone (407) 522-5683

Other identifiers 2

IdentifierTypeStateIssuer
1659441624OtherFLNPI
031807800MedicaidFL

National Provider Directory

National Provider Directory

Locations

1507 Park Center Dr
Ste 1K
Orlando, FL 32835
Phone (407) 405-0735

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1659441624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 PARK CENTER DRIVE",
            "address_2": "SUITE 1K",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355795",
            "telephone_number": "407-522-5683",
            "fax_number": "407-522-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 PARK CENTER DRIVE",
            "address_2": "SUITE 1K",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355795",
            "telephone_number": "407-405-0735",
            "fax_number": "407-522-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SPECIALTY PHARMACY MEDICAL EQUIPMENT AND SUPPLIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "AYOTUNDE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "407-522-5683"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "FL",
            "license": "PH 22346",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1659441624",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031807800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 5, 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.