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General NPI Number Information
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NPI Number | 1538754916
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Entity Type | Organization
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Legal Business Name | AT YOUR SERVICE PHARMACY
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Dates
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Enumeration Date | 03/07/2021
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Last Update Date | 03/07/2021
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Provider Practice Location Address
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Address Line | 692 SW PRIMA VISTA BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1835
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Country | US
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Telephone | 305-528-6539
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 SW GRANT AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1025
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Country | US
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Telephone | 305-528-6539
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | VALANTINA B MORANCY-CALDERON
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Credential | RPH, BCMTMS, CPH
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Telephone | 561-319-5634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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