Healthcare Provider Details

I. General information

NPI: 1518466275
Provider Name (Legal Business Name): BUENO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 S ORLANDO DR STE 130
SANFORD FL
32773-4106
US

IV. Provider business mailing address

2921 S ORLANDO DR STE 130
SANFORD FL
32773-4106
US

V. Phone/Fax

Practice location:
  • Phone: 646-202-3418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH31155
License Number StateFL

VIII. Authorized Official

Name: ANTHONY MALDONADO
Title or Position: MRG
Credential:
Phone: 646-202-3418