Healthcare Provider Details

I. General information

NPI: 1720664709
Provider Name (Legal Business Name): OVIEDO PHARMACY AND DRUG STORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S. CENTRAL AVE
OVIEDO FL
32765-3276
US

IV. Provider business mailing address

784 S CENTRAL AVE
OVIEDO FL
32765-8060
US

V. Phone/Fax

Practice location:
  • Phone: 407-977-9779
  • Fax:
Mailing address:
  • Phone: 407-977-9779
  • Fax: 407-977-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN TASMAN
Title or Position: PHARMACIST
Credential:
Phone: 407-977-9779