Organization
CLOVER PHARMACY INC
Active
Other names
CLOVER PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL RAVELO (OWNER)
(772) 206-5054
Entity
Organization
Contact information
Practice address
259-357 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952
(772) 333-2585
(772) 333-2597
Mailing address
259-357 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952
(772) 333-2585
(772) 333-2597
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH28830
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149942
PK
—
Enumeration date
02/04/2015
Last updated
02/04/2015
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