Healthcare Provider Details

I. General information

NPI: 1497891006
Provider Name (Legal Business Name): PIERSON COMMUNITY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E 1ST AVE
PIERSON FL
32180-3039
US

IV. Provider business mailing address

112 E 1ST AVE
PIERSON FL
32180-3039
US

V. Phone/Fax

Practice location:
  • Phone: 386-749-9557
  • Fax: 386-749-9512
Mailing address:
  • Phone: 386-749-9557
  • Fax: 386-749-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21027
License Number StateFL

VIII. Authorized Official

Name: FRANK FRANCIS
Title or Position: CONSULTANT
Credential:
Phone: 386-749-9557