Organization
ANNALICE LLC
Active
Other names
Pegasus Rx Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON OHIHOIN (PRESIDENT)
(727) 534-1318
Entity
Organization
Contact information
Practice address
1992 ALT US HIGHWAY 19, TARPON SPRINGS, FL 34689
(727) 938-6400
(727) 938-6433
Mailing address
1992 ALT US HIGHWAY 19, TARPON SPRINGS, FL 34689
(727) 938-6400
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24481
FL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002335600
—
FL
01
—
2124203
PK
—
Enumeration date
03/11/2010
Last updated
03/01/2017
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