| NPI | 1568891125 |
|---|---|
| Doing Business As | PROVIDENCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | EDWIN ASANTE Pharmacist 863-937-8092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH27055) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2017-01-20 |