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General NPI Number Information
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NPI Number | 1558759266
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Entity Type | Organization
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Legal Business Name | PERFORMSPECIALTY, LLC
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 2416 LAKE ORANGE DR SUITE 190
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City | ORLANDO
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State | FL
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Zip | 32837-7812
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Country | US
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Telephone | 407-956-1220
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Fax | 407-738-4802
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Provider Business Mailing Address
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Address Line | 2416 LAKE ORANGE DR SUITE 190
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City | ORLANDO
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State | FL
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Zip | 32837-7812
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Country | US
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Telephone | 407-956-1220
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Fax | 407-738-4802
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Authorized Official
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Title or Position | SENIOR COUNSEL
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Name | MR. ROBERT TOOTLE
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Credential |
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Telephone | 215-937-8561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PS28204
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License Number State | FL
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