Healthcare Provider Details

I. General information

NPI: 1093597544
Provider Name (Legal Business Name): PBJ MEDICAL RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 W SAND LAKE RD
ORLANDO FL
32819-5248
US

IV. Provider business mailing address

7380 W SAND LAKE RD STE 500
ORLANDO FL
32819-5257
US

V. Phone/Fax

Practice location:
  • Phone: 800-485-7962
  • Fax:
Mailing address:
  • Phone: 800-485-7962
  • Fax: 888-492-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DWAYNE JONES SR.
Title or Position: OPERATION MANAGER
Credential: PHARMACIST
Phone: 800-485-7962