Organization
PROVIDENCE PHARMACY LLC
Active
Other names
PROVIDENCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN ASANTE (PHARMACIST)
(863) 937-8092
Entity
Organization
Contact information
Practice address
5515 US HIGHWAY 98 N STE 1, LAKELAND, FL 33809-3133
(863) 937-8092
(863) 937-8093
Mailing address
7774 CANTERBURY CIR, LAKELAND, FL 33810-3408
(863) 255-8777
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH27055
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010969100
—
FL
01
—
2143281
PK
—
Enumeration date
11/04/2013
Last updated
01/20/2017
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