Healthcare Provider Details

I. General information

NPI: 1457223844
Provider Name (Legal Business Name): PAUL TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BROADWAY
KISSIMMEE FL
34741-5408
US

IV. Provider business mailing address

22 BROADWAY
KISSIMMEE FL
34741-5408
US

V. Phone/Fax

Practice location:
  • Phone: 407-750-5999
  • Fax:
Mailing address:
  • Phone: 407-750-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH31537
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH31537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: