MEDICARE: PEE JAY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336S0011X	Specialty Pharmacy
5	3336C0003X	Community/Retail Pharmacy	PH6842	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2006756	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447347638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEE JAY INC

Provider Business Mailing Address
First Line	:	2521 13TH ST
Second Line	:	STE A
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-4119
Country	:	US
Telephone Number	:	407-892-7166
Fax Number	:	407-892-0546

Provider Business Practice Location Address
First Line	:	2521 13TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-4119
Country	:	US
Telephone Number	:	407-892-7166
Fax Number	:	407-892-0546

Authorized Official
Title or Position	:	PRES/OWNER
Name	:	ERIC LARSON
Credential	:
Telephone Number	:	407-892-7166

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	08/18/2022

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Directions to “PEE JAY INC ” Practice Location

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