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General NPI Number Information
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NPI Number | 1588310239
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Entity Type | Organization
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Legal Business Name | PINE BROOK PHARMACY LLC
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 14111 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-2707
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Country | US
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Telephone | 352-610-4347
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Fax | 352-610-4349
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Provider Business Mailing Address
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Address Line | 14111 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-2707
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Country | US
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Telephone | 352-610-4347
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Fax | 352-610-4349
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Authorized Official
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Title or Position | PHARMACY SUPERVISOR
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Name | DOROTHY SCHMECKPEPER
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Credential |
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Telephone | 352-610-4347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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