Healthcare Provider Details

I. General information

NPI: 1326182023
Provider Name (Legal Business Name): EXPRESS APOTHECARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 OAK WEST ST
KISSIMMEE FL
34741
US

IV. Provider business mailing address

325 OAK WEST ST
KISSIMMEE FL
34741
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-0033
  • Fax: 407-932-0083
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH21586
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PRUITT
Title or Position: MANAGER
Credential: PHARMD
Phone: 407-902-8607