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Organization
PACIFICO NATIONAL INC
Active
Organization
PACIFICO NATIONAL INC
Active
Other names
AMEX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SANGREE (PRES)
(321) 872-0723
Entity
Organization
Contact information
Practice address
1515 ELIZABETH ST, STE J, MELBOURNE, FL 32901-3000
(321) 872-0723
(321) 872-0721
Mailing address
1515 ELIZABETH ST, STE J, MELBOURNE, FL 32901-3000
(321) 872-0723
(321) 872-0721
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
006292
LA
3336C0004X
Compounding Pharmacy
054.016601
IL
3336C0004X
Compounding Pharmacy
16452MS
ID
3336C0004X
Compounding Pharmacy
22-02899
KS
3336C0004X
Compounding Pharmacy
3942
IA
3336C0004X
Compounding Pharmacy
5301008923
MI
3336C0004X
Compounding Pharmacy
64000903A
IN
3336C0004X
Compounding Pharmacy
A9-0001042
DE
3336C0004X
Compounding Pharmacy
FL1446
KY
3336C0004X
Compounding Pharmacy
NRX1701137
DC
3336C0004X
Compounding Pharmacy
P03052
MD
3336C0004X
Compounding Pharmacy
PH27532
FL
3336C0004X
Compounding Pharmacy
PHNR 000556
GA
3336C0004X
Compounding Pharmacy
PMP-1330
HI
3336C0004X
Compounding Pharmacy
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02199910
—
FL
05
—
1000055714
—
WI
05
—
10026562600
—
NE
05
—
1028490
—
VT
05
—
105780400
—
MD
05
—
134038
—
AZ
05
—
1366416448
—
ID
05
—
1366416448
—
IL
05
—
1366416448
—
MN
05
—
1366416448
—
NM
05
—
1366416448
—
UT
05
—
200647710A
—
OK
01
—
2013120
PK
—
05
—
201352590A
—
IN
05
—
2059467
—
WA
05
—
226807
—
NH
05
—
2856995
—
OH
05
—
500707688
—
OR
05
—
546330
—
NJ
05
—
7100410000
—
KY
Enumeration date
02/15/2006
Last updated
04/20/2017
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