Healthcare Provider Details

I. General information

NPI: 1528616596
Provider Name (Legal Business Name): ORLANDO HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 RINEHART RD
LAKE MARY FL
32746
US

IV. Provider business mailing address

PO BOX 568624
ORLANDO FL
32856-8624
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-0640
  • Fax: 321-842-0641
Mailing address:
  • Phone: 321-842-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN J GASPELIN
Title or Position: DIRECTOR OF FINANCE/REVENUE
Credential:
Phone: 321-841-6308