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General NPI Number Information
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NPI Number | 1245631936
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Entity Type | Organization
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Legal Business Name | A & B PHARMACEUTICAL SERVICES INC
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 4750 E MOODY BLVD STE 107
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City | BUNNELL
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State | FL
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Zip | 32110-7710
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Country | US
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Telephone | 386-313-6959
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Fax | 386-313-6965
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Provider Business Mailing Address
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Address Line | 4750 E MOODY BLVD SUITE 107
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City | BUNNELL
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State | FL
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Zip | 32110-7709
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Country | US
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Telephone | 386-313-6959
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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 | BISHASWAR MAHADEO
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Credential |
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Telephone | 386-569-6056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28242
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License Number State | FL
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