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General NPI Number Information
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NPI Number | 1396167623
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Entity Type | Organization
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Legal Business Name | HEALTHPROMOTE PHARMACY LLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 12701 S JOHN YOUNG PKWY STE 120
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City | ORLANDO
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State | FL
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Zip | 32837-3422
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Country | US
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Telephone | 321-319-1090
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Fax | 407-601-7142
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Provider Business Mailing Address
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Address Line | 12701 S JOHN YOUNG PKWY STE 120
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City | ORLANDO
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State | FL
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Zip | 32837-3422
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Country | US
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Telephone | 321-319-1090
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Fax | 407-601-7142
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Authorized Official
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Title or Position | MANAGING MBR/OWNER
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Name | MR. OMAR MEDINA
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Credential |
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Telephone | 321-319-1090
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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 | PH27352
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License Number State | FL
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