Organization
STOBIDEK, INC
Active
Organization
STOBIDEK, INC
Active
Other names
DIVINE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PETER ELIOGU (PHARMACIST IN CHARGE)
(352) 793-2679
Entity
Organization
Contact information
Practice address
1333 W C 48 STE A, BUSHNELL, FL 33513-8923
(352) 793-2679
(352) 793-3125
Mailing address
1333 W C 48 STE A, BUSHNELL, FL 33513-8923
(352) 793-2679
(352) 793-3125
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24149
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019905200
—
FL
01
—
2120956
PK
—
Enumeration date
07/07/2009
Last updated
06/02/2017
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