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General NPI Number Information
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NPI Number | 1891184859
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Entity Type | Organization
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Legal Business Name | PRESCRIPTION PLACE OF NICEVILLE LLC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 1140 JOHN SIMS PKWY E SUITE 6
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City | NICEVILLE
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State | FL
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Zip | 32578-2204
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Country | US
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Telephone | 850-389-8182
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Fax | 850-389-8185
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Provider Business Mailing Address
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Address Line | 1140 JOHN SIMS PKWY E SUITE 6
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City | NICEVILLE
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State | FL
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Zip | 32578-2204
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Country | US
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Telephone | 850-892-6898
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Fax | 850-389-8182
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Authorized Official
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Title or Position | OWNER
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Name | SHANE G ABBOTT
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Credential |
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Telephone | 850-389-8182
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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 | PH28801
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License Number State | FL
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