Organization
PUBLIX PHARMACY #1433
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETE SENCHYSHAK RPH (PHARMACY MANAGER)
(941) 705-8785
Entity
Organization
Contact information
Practice address
2438 LAUREL RD E, NORTH VENICE, FL 34275-3204
(941) 488-2459
Mailing address
2438 LAUREL RD E, NORTH VENICE, FL 34275-3204
(941) 488-2459
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2141338
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009582700
MEDICAID FL
FL
01
—
1356783823
NPI
FL
01
—
80-8012726187-6
CONSOLIDATED
FL
Enumeration date
07/29/2014
Last updated
07/29/2014
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