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General NPI Number Information
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NPI Number | 1023156106
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Entity Type | Organization
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Legal Business Name | SUPER SAVER PHARMACY # 2
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 PARK PLACE BLVD
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City | KISSIMMEE
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State | FL
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Zip | 34741-2344
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Country | US
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Telephone | 407-846-0765
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Fax |
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Provider Business Mailing Address
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Address Line | 4433 LAKE CALABAY DR
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City | ORLANDO
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State | FL
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Zip | 32837-5468
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Country | US
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Telephone | 407-852-3161
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MRS. CHARLENE MATHURA
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Credential | RPH
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Telephone | 407-846-0765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PH21929
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License Number State | FL
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