Healthcare Provider Details

I. General information

NPI: 1639524010
Provider Name (Legal Business Name): DR. MARK BORNSTEIN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E MICHIGAN ST
ORLANDO FL
32806-4623
US

IV. Provider business mailing address

701 E MICHIGAN ST
ORLANDO FL
32806-4623
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-4206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPO1420
License Number StateFL

VIII. Authorized Official

Name: DR. MARK BORNSTEIN
Title or Position: DOCTOR
Credential: DPM
Phone: 407-310-8093