Healthcare Provider Details

I. General information

NPI: 1164050761
Provider Name (Legal Business Name): PCA FLORIDA RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 CRESCENT PARK DR
RIVERVIEW FL
33578-3605
US

IV. Provider business mailing address

303 N HURSTBOURNE PKWY STE 200
LOUISVILLE KY
40222-5158
US

V. Phone/Fax

Practice location:
  • Phone: 813-499-9340
  • Fax:
Mailing address:
  • Phone: 813-499-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 502-412-5847