Organization
EBENEZER CLINICAL PHARMACY LLC
Active
Other names
EBENEZER CLINICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TINA IHERA (PHARMACIST/OWNER)
(407) 969-8130
Entity
Organization
Contact information
Practice address
4073 13TH ST, SAINT CLOUD, FL 34769
(407) 891-9280
(407) 891-9200
Mailing address
4073 13TH ST, SAINT CLOUD, FL 34769
(407) 891-9280
(407) 891-9200
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH30718
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2171741
PK
—
Enumeration date
05/11/2017
Last updated
04/10/2023
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