Organization
MOON LAKE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIVIAN ALBERTO (PRESIDENT)
(727) 846-1800
Entity
Organization
Contact information
Practice address
9111 RIDGE RD, NEW PORT RICHEY, FL 34654-5059
(727) 846-1800
(727) 846-1822
Mailing address
9111 RIDGE RD, NEW PORT RICHEY, FL 34654-5059
(727) 846-1800
(727) 846-1822
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH 22873
FL
Other
Enumeration date
10/16/2007
Last updated
10/16/2007
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