Healthcare Provider Details

I. General information

NPI: 1972500130
Provider Name (Legal Business Name): CREATIVE PHARMACY SOLUTIONS EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7779 STARKEY RD
SEMINOLE FL
33777-4346
US

IV. Provider business mailing address

2535 JOHNS PL
JAMESTOWN NY
14701-9210
US

V. Phone/Fax

Practice location:
  • Phone: 727-381-9799
  • Fax: 716-708-6248
Mailing address:
  • Phone: 716-720-5121
  • Fax: 716-708-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30191
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MOON
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 716-720-5121