=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528499191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION CARE PHARMACY SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2013
-----------------------------------------------------
Last Update Date | 12/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2131 NW 55TH TER
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32605-3374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-634-2094
-----------------------------------------------------
Fax | 888-634-2090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 358920
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32635-8882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | DR. ZANETA DORETHA ALLEN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 888-634-2094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PU6319
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------