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General NPI Number Information
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NPI Number | 1770870628
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Entity Type | Organization
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Legal Business Name | LEGACY PARK DISCOUNT PHARMACY
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 10967 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-4457
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Country | US
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Telephone | 407-730-7989
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Fax | 407-730-7995
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Provider Business Mailing Address
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Address Line | 10967 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-4457
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Country | US
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Telephone | 407-730-7989
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Fax | 407-730-7995
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ASHISHKUMAR K SMART
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Credential |
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Telephone | 321-278-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25547
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License Number State | FL
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