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General NPI Number Information
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NPI Number | 1255827309
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Entity Type | Organization
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Legal Business Name | ST.CLOUD PHARMACY&WELLNESS CENTER
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | ST.CLOUD PHARMACY & WELLNESS CENTER 1503, BILLBECK BLVD
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City | KISSIMMEE
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State | FL
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Zip | 34744
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Country | US
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Telephone | 407-593-2959
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Fax |
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Provider Business Mailing Address
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Address Line | ST.CLOUD PHARMACY & WELLNESS CENTER 1503, BILLBECK BLVD
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City | KISSIMMEE
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State | FL
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Zip | 34744
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Country | US
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Telephone | 407-593-2959
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | SAJI THOMAS
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Credential |
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Telephone | 407-593-2959
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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 | PH25210
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License Number State | FL
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