Provider Demographics
NPI:1003457946
Name:NESO PHARMACY INC.
Entity Type:Organization
Organization Name:NESO PHARMACY INC.
Other - Org Name:NESO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZEPUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:786-202-7867
Mailing Address - Street 1:6230 SW HIGHWAY 200 UNIT 1
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-5606
Mailing Address - Country:US
Mailing Address - Phone:352-644-4268
Mailing Address - Fax:352-484-0984
Practice Address - Street 1:6230 SW HIGHWAY 200 UNIT 1
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-5606
Practice Address - Country:US
Practice Address - Phone:352-644-4268
Practice Address - Fax:352-484-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104685100Medicaid