Provider Demographics
NPI:1053834267
Name:SPNN LLC
Entity Type:Organization
Organization Name:SPNN LLC
Other - Org Name:BE WELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-372-5600
Mailing Address - Street 1:5429 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1107
Mailing Address - Country:US
Mailing Address - Phone:727-372-5600
Mailing Address - Fax:727-372-5603
Practice Address - Street 1:5429 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:717-507-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH308463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy