Provider Demographics
NPI:1871940148
Name:OPS PHARMACY LLC
Entity type:Organization
Organization Name:OPS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:CHIRANJIVI
Authorized Official - Middle Name:BHARATH
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-223-8864
Mailing Address - Street 1:1110 DRUID CIR STE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4307
Mailing Address - Country:US
Mailing Address - Phone:863-300-1984
Mailing Address - Fax:863-300-1985
Practice Address - Street 1:1110 DRUID CIR STE E
Practice Address - Street 2:SUITE E
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4307
Practice Address - Country:US
Practice Address - Phone:863-300-1984
Practice Address - Fax:863-300-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH301333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017996600Medicaid
2160193OtherPK