Healthcare Provider Details

I. General information

NPI: 1912328048
Provider Name (Legal Business Name): S.A.S.B. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SW PARK ST
OKEECHOBEE FL
34972-4160
US

IV. Provider business mailing address

203 SW PARK ST
OKEECHOBEE FL
34972-4160
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-5100
  • Fax: 863-763-7550
Mailing address:
  • Phone: 863-763-5100
  • Fax: 863-763-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1045738
License Number StateFL

VIII. Authorized Official

Name: STEVEN D NELSON
Title or Position: OWNER
Credential: PHARMACIST
Phone: 863-763-5100