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General NPI Number Information
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NPI Number | 1285042739
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Entity Type | Organization
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Legal Business Name | PUBLIX PHARMACY #1433
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 2438 LAUREL RD E
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City | NORTH VENICE
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State | FL
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Zip | 34275-3204
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Country | US
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Telephone | 941-488-2459
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Fax |
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Provider Business Mailing Address
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Address Line | 2438 LAUREL RD E
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City | NORTH VENICE
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State | FL
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Zip | 34275-3204
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Country | US
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Telephone | 941-488-2459
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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 | PETE SENCHYSHAK
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Credential | RPH
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Telephone | 941-705-8785
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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 | 2141338
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License Number State | FL
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