=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699674770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY FSI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2240 WOOD STORK LN
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34771-8428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-888-0627
-----------------------------------------------------
Fax | 870-888-0627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 NE 191ST ST STE 43662
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-3899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-888-0627
-----------------------------------------------------
Fax | 870-888-0627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBR
-----------------------------------------------------
Name | ANNELVIS GARCIA NIEVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-888-0627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------