Healthcare Provider Details

I. General information

NPI: 1104785112
Provider Name (Legal Business Name): EAGLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAGLES LANDING DR STE 250
LAKELAND FL
33810-3041
US

IV. Provider business mailing address

1 HEALTHCARE WAY
LAKEWOOD NJ
08701-5400
US

V. Phone/Fax

Practice location:
  • Phone: 833-819-0923
  • Fax:
Mailing address:
  • Phone: 833-819-0923
  • Fax:

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

VIII. Authorized Official

Name: HENRY BURGESS
Title or Position: PRESIDENT, PHARMACY SERVICES
Credential: PHARMD
Phone: 833-819-0923