Organization
ANNALICE LLC
Active
Other names
Pegasus Rx Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON OHIHOIN (CEO)
(727) 534-1318
Entity
Organization
Contact information
Practice address
115 W BELT AVE, BUSHNELL, FL 33513-5101
(352) 793-3100
(352) 793-3106
Mailing address
115 W BELT AVE, BUSHNELL, FL 33513-5101
(352) 793-3100
(352) 793-3106
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001215500
—
FL
01
—
2120290
PK
—
Enumeration date
05/08/2009
Last updated
03/01/2017
Update your record
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