Organization
AGEVITAL PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY P. WILKINS (PROPRIETOR/GENERAL MANAGER)
(941) 928-8066
Entity
Organization
Contact information
Practice address
16 S BLVD OF THE PRESIDENTS, SARASOTA, FL 34236-1424
(941) 928-8066
Mailing address
16 S BLVD OF THE PRESIDENTS, SARASOTA, FL 34236-1424
(941) 928-8066
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
02/10/2013
Last updated
02/10/2013
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