Healthcare Provider Details

I. General information

NPI: 1942585419
Provider Name (Legal Business Name): PHMN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 PARK BLVD
PINELLAS PARK FL
33781
US

IV. Provider business mailing address

4616 PARK BLVD
PINELLAS PARK FL
33781
US

V. Phone/Fax

Practice location:
  • Phone: 727-827-2947
  • Fax:
Mailing address:
  • Phone: 727-827-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25709
License Number StateFL

VIII. Authorized Official

Name: PHUOC NGUYEN
Title or Position: PHARMACY MANAGER
Credential:
Phone: 727-827-2947