Healthcare Provider Details

I. General information

NPI: 1740089713
Provider Name (Legal Business Name): PINE HILLS DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W COLONIAL DR STE 100
ORLANDO FL
32808-7602
US

IV. Provider business mailing address

5000 W COLONIAL DR STE 100
ORLANDO FL
32808-7602
US

V. Phone/Fax

Practice location:
  • Phone: 407-291-1236
  • Fax:
Mailing address:
  • Phone: 407-291-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHIMEZIRI OSCAR MBIONWU
Title or Position: OWNER
Credential: RPH
Phone: 407-291-1236