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General NPI Number Information
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NPI Number | 1083055891
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Entity Type | Organization
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Legal Business Name | PREMIUM RX PHARMACY
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 2750 BAHIA VISTA ST SUITE 235
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City | SARASOTA
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State | FL
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Zip | 34239-2600
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Country | US
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Telephone | 727-460-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 BAHIA VISTA ST. SUITE 235
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 727-460-1855
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DEAN A PEDALINO
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Credential | PHARMACIST
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Telephone | 727-460-1855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH 26669
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License Number State | FL
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