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General NPI Number Information
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NPI Number | 1144914201
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Entity Type | Organization
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Legal Business Name | PIONEER RX PHARMACY LLC
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 494 PONDEROSA DR
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1656
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Country | US
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Telephone | 407-968-4218
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Fax |
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Provider Business Mailing Address
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Address Line | 494 PONDEROSA DR
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1656
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Country | US
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Telephone | 407-968-4218
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | SAJI THOMAS
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Credential |
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Telephone | 407-593-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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