Healthcare Provider Details

I. General information

NPI: 1598678732
Provider Name (Legal Business Name): EAGLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAGLES LANDING DR STE 280
LAKELAND FL
33810-3041
US

IV. Provider business mailing address

350 EAGLES LANDING DR
LAKELAND FL
33810-2999
US

V. Phone/Fax

Practice location:
  • Phone: 855-748-2663
  • Fax:
Mailing address:
  • Phone: 855-748-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. HENRY BURGESS III
Title or Position: CPS, PRESIDENT
Credential:
Phone: 919-627-1053