Organization
HUMANA MEDICAL PLAN INC
Active
Other names
HUMANA PHARMACY 47906
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WALLACE (MANAGER)
(954) 926-2914
Entity
Organization
Contact information
Practice address
2216 HOLLYWOOD BLVD, HOLLYWOOD, FL 33020-6702
(954) 926-2914
(954) 926-2957
Mailing address
2216 HOLLYWOOD BLVD, HOLLYWOOD, FL 33020-6702
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
PH09985
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1071959
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
08/22/2020
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