Provider Demographics
NPI:1205356086
Name:PACE PHARMACY, LLC
Entity Type:Organization
Organization Name:PACE PHARMACY, LLC
Other - Org Name:PACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-463-4232
Mailing Address - Street 1:4880 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8762
Mailing Address - Country:US
Mailing Address - Phone:850-463-4232
Mailing Address - Fax:850-463-4236
Practice Address - Street 1:4880 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8762
Practice Address - Country:US
Practice Address - Phone:850-463-4232
Practice Address - Fax:850-463-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy