Organization
AETNA RX HOME DELIVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOKUNBO NIKE KASSIM (DIR, PHARMACIST IN CHARGE)
(959) 299-3008
Entity
Organization
Contact information
Practice address
1600 SW 80TH TER, 2ND FLOOR, PLANTATION, FL 33324-4049
(954) 693-2800
(954) 693-2905
Mailing address
1600 SW 80TH TER FL 2, PLANTATION, FL 33324-4049
(866) 612-3862
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH21465
FL
3336M0002X
Mail Order Pharmacy
Primary
PH21465
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH21465
STATE LICENSE
FL
Enumeration date
06/04/2006
Last updated
03/01/2019
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