Provider Demographics
NPI:1073098489
Name:ST.CLOUD PHARMACY&WELLNESS CENTER
Entity Type:Organization
Organization Name:ST.CLOUD PHARMACY&WELLNESS CENTER
Other - Org Name:ST.CLOUD COMPOUNDING PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-593-2959
Mailing Address - Street 1:2801 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4134
Mailing Address - Country:US
Mailing Address - Phone:407-593-2959
Mailing Address - Fax:
Practice Address - Street 1:2801 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4134
Practice Address - Country:US
Practice Address - Phone:407-593-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST.CLOUD PHARMACY &WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy