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General NPI Number Information
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NPI Number | 1386060580
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Entity Type | Organization
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Legal Business Name | AETNA SPECIALTY PHARMACY
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 503 SUNPORT LN
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City | ORLANDO
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State | FL
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Zip | 32809-7874
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Country | US
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Telephone | 407-513-1880
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Fax |
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Provider Business Mailing Address
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Address Line | 503 SUNPORT LN
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City | ORLANDO
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State | FL
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Zip | 32809-7874
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | NEREIDA PADILLA
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Credential | RPH
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Telephone | 407-513-8626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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