Healthcare Provider Details

I. General information

NPI: 1346410537
Provider Name (Legal Business Name): 17TH STREET DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 SE 17TH ST STE B
OCALA FL
34471-5523
US

IV. Provider business mailing address

2506 SE 17TH ST STE B
OCALA FL
34471-5523
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-3330
  • Fax: 352-351-3390
Mailing address:
  • Phone: 352-351-3330
  • Fax: 352-351-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARA ALDERMAN
Title or Position: OWNER AND PHARMACIST
Credential: RPH
Phone: 352-351-3330