Healthcare Provider Details

I. General information

NPI: 1457689812
Provider Name (Legal Business Name): SUPER SAVER PHARMACY 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W OAK RIDGE RD
ORLANDO FL
32809-3962
US

IV. Provider business mailing address

1800 W OAK RIDGE RD
ORLANDO FL
32809-3962
US

V. Phone/Fax

Practice location:
  • Phone: 407-472-6580
  • Fax: 407-472-6581
Mailing address:
  • Phone: 407-472-6580
  • Fax: 407-472-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number24341
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MILLER
Title or Position: CEO
Credential:
Phone: 516-308-4335