Provider Demographics
NPI:1083474217
Name:BUENO PHARMACY LLC
Entity Type:Organization
Organization Name:BUENO PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:646-202-3418
Mailing Address - Street 1:2921 S ORLANDO DR STE 130
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4106
Mailing Address - Country:US
Mailing Address - Phone:855-283-6679
Mailing Address - Fax:
Practice Address - Street 1:2921 S ORLANDO DR STE 130
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4106
Practice Address - Country:US
Practice Address - Phone:855-283-6679
Practice Address - Fax:407-878-3106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUENO PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy