Healthcare Provider Details

I. General information

NPI: 1205356086
Provider Name (Legal Business Name): PACE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 WOODBINE RD
PACE FL
32571-8762
US

IV. Provider business mailing address

4880 WOODBINE RD
PACE FL
32571-8762
US

V. Phone/Fax

Practice location:
  • Phone: 850-463-4232
  • Fax: 850-463-4236
Mailing address:
  • Phone: 850-463-4232
  • Fax: 850-463-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPENDING
License Number StateFL

VIII. Authorized Official

Name: STEPHEN BURKLOW
Title or Position: OWNER
Credential: RPH
Phone: 850-463-4232