Organization
INDIAN RIVER PHARMACY
Active
Other names
INDIAN RIVER INFUSION SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY MICHEAEL DECRESCENZO R.PH. (PRESIDENT)
(772) 567-2557
Entity
Organization
Contact information
Practice address
3719 10TH CT, VERO BEACH, FL 32960-6559
(772) 567-2557
(772) 567-0013
Mailing address
3719 10TH CT, VERO BEACH, FL 32960-6559
(772) 567-2557
(772) 567-0013
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PH19077
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001154
NCPDP
FL
Enumeration date
05/16/2007
Last updated
08/22/2020
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