Organization
FENIX DRUG STORE, LLC
Active
Organization
FENIX DRUG STORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA HOLMES (MANAGING MEMBER)
(888) 511-1517
Entity
Organization
Contact information
Practice address
527 13TH ST W, BRADENTON, FL 34205
(888) 511-1517
Mailing address
527 13TH ST W, BRADENTON, FL 34205
(888) 511-1517
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH32150
PHARMACY LICENSE
FL
Enumeration date
10/02/2019
Last updated
10/02/2019
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