Organization
AETNA SPECIALTY PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN R. CARNEY (SR. PHARMACY OPS MGR)
(407) 513-6495
Entity
Organization
Contact information
Practice address
503 SUNPORT LANE, ORLANDO, FL 32809-7874
(407) 513-6400
(866) 329-2779
Mailing address
503 SUNPORT LANE, ORLANDO, FL 32809-7874
(407) 513-6400
(866) 329-2779
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
PH21035
FL
3336S0011X
Specialty Pharmacy
Primary
PH21035
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0215059
—
MT
05
—
030961300
—
FL
05
—
035123
—
AZ
05
—
057738300
—
MN
05
—
0720789
—
IA
05
—
100508643
—
NV
05
—
1016502540001
—
PA
01
—
1714655
AETNA HEALTHCARE
—
05
—
1942203187
—
VA
05
—
200077510A
—
OK
05
—
200369680A
—
KS
05
—
200808960A
—
IN
05
—
35123
—
AZ
01
—
3726379
AETNA HEALTHCARE HMO CLMS
—
05
—
38457750
—
NM
05
—
411068400
—
MD
05
—
432182200
—
ME
05
—
582713
—
HI
05
—
6029037
—
WA
01
—
7446672
AETNA HEALTHCARE DIEM CLAIM
—
05
—
7F1035
—
SC
05
—
807415000
—
ID
05
—
PH575FL
—
AK
Enumeration date
05/23/2005
Last updated
05/19/2014
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