Organization
MY PHARMACY OF BIG BEND, INC.
Active
Organization
MY PHARMACY OF BIG BEND, INC.
Active
Other names
My Pharmacy of Big Bend
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATHEW RYAN GONZALES (PRESIDENT)
(813) 699-3496
Entity
Organization
Contact information
Practice address
538 WILBUR ST, BRANDON, FL 33511-5324
(813) 699-3496
(813) 699-5190
Mailing address
538 WILBUR ST, BRANDON, FL 33511-5324
(813) 699-3496
(813) 699-5190
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009863500
—
FL
Enumeration date
07/25/2013
Last updated
04/17/2020
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