Healthcare Provider Details

I. General information

NPI: 1407440290
Provider Name (Legal Business Name): ST.CLOUD PHARMACY & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 13TH ST
SAINT CLOUD FL
34769-4134
US

IV. Provider business mailing address

2801 13TH ST
SAINT CLOUD FL
34769-4134
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-2959
  • Fax: 407-593-2957
Mailing address:
  • Phone: 407-593-2959
  • Fax: 407-593-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SIBY THOMAS PUTHENPURAYIL
Title or Position: MANAGER
Credential: RPH
Phone: 407-593-2959