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General NPI Number Information
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NPI Number | 1689347064
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Entity Type | Organization
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Legal Business Name | GHOST RX INC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 1561 S ALAFAYA TRL STE 200
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City | ORLANDO
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State | FL
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Zip | 32828-8956
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Country | US
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Telephone | 704-996-6086
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Fax |
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Provider Business Mailing Address
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Address Line | 1561 S ALAFAYA TRL STE 200
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City | ORLANDO
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State | FL
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Zip | 32828-8956
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Country | US
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Telephone | 704-996-6086
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAKE MYERS
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Credential |
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Telephone | 704-996-6086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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