Organization
PROFESSIONAL PHARMACY RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA TISDALE (ADMIN ASSIST)
(866) 236-5040
Entity
Organization
Contact information
Practice address
4854 WOODBINE RD UNIT 5, PACE, FL 32571-8709
(866) 236-5040
Mailing address
4854 WOODBINE RD UNIT 5, PACE, FL 32571-8709
(866) 236-5040
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH31350
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH31350
FL DEPARTMENT OF HEALTH
FL
Enumeration date
05/13/2018
Last updated
05/13/2018
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