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General NPI Number Information
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NPI Number | 1912034265
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Entity Type | Organization
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Legal Business Name | XTRA DISCOUNT DRUGS HC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 401 EAST HINSON AVE
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City | HAINES CITY
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State | FL
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Zip | 33844
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Country | US
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Telephone | 863-421-6399
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Fax | 863-422-7004
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Provider Business Mailing Address
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Address Line | 401 EAST HINSON AVE
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City | HAINES CITY
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State | FL
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Zip | 33844
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Country | US
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Telephone | 863-421-6399
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Fax | 863-422-7004
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JIMMY THOMAS SETZER
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Credential | REGISTERED PHARMACIS
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Telephone | 205-467-3347
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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 | 013701
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License Number State | FL
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