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General NPI Number Information
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NPI Number | 1427181999
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Entity Type | Organization
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Legal Business Name | FLORIDA AVENUE PRESCRIPTIONS, INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1541 FLORIDA AVE SUITE P
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City | MODESTO
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State | CA
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Zip | 95350-4429
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Country | US
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Telephone | 209-576-7277
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Fax | 209-576-1220
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Provider Business Mailing Address
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Address Line | 1541 FLORIDA AVE SUITE P
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City | MODESTO
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State | CA
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Zip | 95350-4429
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Country | US
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Telephone | 209-576-7277
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Fax | 209-576-1220
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK VICTOR PARDINI
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Credential | PHARM.D.
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Telephone | 209-576-7277
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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 | PHY38942
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License Number State | CA
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