Organization
RADIANCE ENTERPRISES INC
Active
Other names
Bushnell Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JACK DIAMOND (PHARMACY MANAGER)
(352) 569-5800
Entity
Organization
Contact information
Practice address
417 N WEST ST, BUSHNELL, FL 33513-6021
(352) 569-5800
(352) 569-5802
Mailing address
417 N WEST ST, BUSHNELL, FL 33513-6021
(352) 569-5800
(352) 569-5802
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH25415
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003766100
—
FL
05
—
003766101
—
FL
01
—
2130577
PK
—
Enumeration date
06/02/2011
Last updated
06/08/2023
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