Healthcare Provider Details

I. General information

NPI: 1831610104
Provider Name (Legal Business Name): PCA RX GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9318 E COLONIAL DR
ORLANDO FL
32817-4100
US

IV. Provider business mailing address

9318 E COLONIAL DR
ORLANDO FL
32817-4100
US

V. Phone/Fax

Practice location:
  • Phone: 877-419-4459
  • Fax: 305-397-2527
Mailing address:
  • Phone: 877-419-4459
  • Fax: 305-397-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ARTHUR JAKUBOV
Title or Position: PRESIDENT
Credential:
Phone: 407-491-8178