Organization
PRESCRIPTION PLACE OF NICEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE G ABBOTT (OWNER)
(850) 389-8182
Entity
Organization
Contact information
Practice address
1140 JOHN SIMS PKWY E, SUITE 6, NICEVILLE, FL 32578-2204
(850) 389-8182
(850) 389-8185
Mailing address
1140 JOHN SIMS PKWY E, SUITE 6, NICEVILLE, FL 32578-2204
(850) 892-6898
(850) 389-8182
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH28801
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014786600
—
FL
01
—
PH28801
FLORIDA STATE LICENSE
FL
Enumeration date
01/14/2015
Last updated
02/05/2019
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