Healthcare Provider Details

I. General information

NPI: 1124658935
Provider Name (Legal Business Name): DAYTONA PEOPLES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 ORANGE AVE
DAYTONA BEACH FL
32114-4667
US

IV. Provider business mailing address

968 ORANGE AVE
DAYTONA BEACH FL
32114-4667
US

V. Phone/Fax

Practice location:
  • Phone: 386-888-7500
  • Fax: 386-888-7501
Mailing address:
  • Phone: 386-888-7500
  • Fax: 386-888-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AKINYEMI BAKARE
Title or Position: MGR
Credential: RPH
Phone: 386-888-7500