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General NPI Number Information
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NPI Number | 1700233368
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Entity Type | Organization
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Legal Business Name | SERVICE PRO PHARMACY LLC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 6472 HIGHWAY 90
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City | MILTON
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State | FL
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Zip | 32570-4560
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Country | US
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Telephone | 850-564-0880
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Fax | 850-564-0884
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Provider Business Mailing Address
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Address Line | 6472 HIGHWAY 90
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City | MILTON
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State | FL
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Zip | 32534
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Country | US
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Telephone | 850-564-0880
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Fax | 850-564-0884
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | STUART VIATOR
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Credential |
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Telephone | 850-516-5886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH29970
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License Number State | FL
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