Provider Demographics
NPI:1114540770
Name:PILLS POTIONS & LOTIONS
Entity Type:Organization
Organization Name:PILLS POTIONS & LOTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:772-301-1095
Mailing Address - Street 1:8701 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3333
Mailing Address - Country:US
Mailing Address - Phone:772-301-1095
Mailing Address - Fax:772-333-2728
Practice Address - Street 1:8701 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3333
Practice Address - Country:US
Practice Address - Phone:772-301-1095
Practice Address - Fax:772-333-2728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PILLS POTIONS & LOTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100812400Medicaid