Healthcare Provider Details

I. General information

NPI: 1881052769
Provider Name (Legal Business Name): CONTROLLED RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 L B MCLEOD RD STE C
ORLANDO FL
32811-5660
US

IV. Provider business mailing address

4081 L B MCLEOD RD SUITE C
ORLANDO FL
32811-5660
US

V. Phone/Fax

Practice location:
  • Phone: 407-270-6748
  • Fax: 855-274-0569
Mailing address:
  • Phone: 407-270-6748
  • Fax: 855-274-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TASHIMA KENNY
Title or Position: MANAGER
Credential:
Phone: 407-270-6748