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General NPI Number Information
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NPI Number | 1811053705
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Entity Type | Organization
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Legal Business Name | PINES DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 2020 KINGSLEY AVE STE 2B
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City | ORANGE PARK
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State | FL
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Zip | 32073-5181
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Country | US
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Telephone | 904-527-7330
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Fax | 904-527-7331
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Provider Business Mailing Address
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Address Line | 2020 KINGSLEY AVE STE 2B
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City | ORANGE PARK
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State | FL
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Zip | 32073-5181
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Country | US
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Telephone | 904-527-7330
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Fax | 904-527-7331
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA LEE DALY
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Credential |
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Telephone | 561-214-3828
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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 | PH24151
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License Number State | FL
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