Healthcare Provider Details

I. General information

NPI: 1477095685
Provider Name (Legal Business Name): SERVICE PRO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
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: 850-995-9999
  • Fax: 850-995-0095
Mailing address:
  • Phone: 850-995-9999
  • Fax: 850-995-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number30372
License Number StateFL

VIII. Authorized Official

Name: STUART VIATOR
Title or Position: PRESIDENT
Credential:
Phone: 850-516-5886