Organization
ANNALICE LLC
Active
Other names
Pegasus Rx 002 Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON OHIHOIN (PRESIDENT)
(727) 534-1318
Entity
Organization
Contact information
Practice address
6506 EMBASSY BLVD, PORT RICHEY, FL 34668-4734
(727) 848-9400
Mailing address
6506 EMBASSY BLVD, PORT RICHEY, FL 34668-4734
(727) 848-9400
(727) 848-9401
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH24598
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5700807
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/08/2010
Last updated
10/28/2010
About Stedi
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