Organization
DELTONA PHARMACY OF FLORIDA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS RANDULFE PHRAMD (MANAGING MEMBER)
(239) 317-0771
Entity
Organization
Contact information
Practice address
25987 S TAMIAMI TRL STE 102, BONITA SPRINGS, FL 34134-7807
(239) 317-0771
(386) 574-1489
Mailing address
25987 S TAMIAMI TRL STE 102, BONITA SPRINGS, FL 34134-7807
(239) 317-0771
(239) 317-0771
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH24105
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026286200
—
FL
Enumeration date
12/15/2005
Last updated
12/22/2020
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