Healthcare Provider Details

I. General information

NPI: 1871037333
Provider Name (Legal Business Name): NIGHT OWL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E HIBISCUS BLVD
MELBOURNE FL
32901-3219
US

IV. Provider business mailing address

811 E HIBISCUS BLVD
MELBOURNE FL
32901-3219
US

V. Phone/Fax

Practice location:
  • Phone: 321-914-4909
  • Fax: 321-400-1409
Mailing address:
  • Phone: 321-914-4909
  • Fax: 321-400-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30481
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN ABRAMO
Title or Position: PRESIDENT
Credential:
Phone: 321-749-2009