Healthcare Provider Details

I. General information

NPI: 1992002612
Provider Name (Legal Business Name): PICENTI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11147 COUNTY LINE RD 101
SPRING HILL FL
34609-5619
US

IV. Provider business mailing address

11147 COUNTY LINE RD 101
SPRING HILL FL
34609
US

V. Phone/Fax

Practice location:
  • Phone: 727-244-3670
  • Fax: 352-340-5973
Mailing address:
  • Phone: 727-244-3670
  • Fax: 352-340-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPS 42024
License Number StateFL

VIII. Authorized Official

Name: MR. ALAN TOLBA
Title or Position: MANAGER
Credential:
Phone: 727-244-3670