Provider Demographics
NPI:1235556879
Name:WSRX HEALTHCARE LLC
Entity Type:Organization
Organization Name:WSRX HEALTHCARE LLC
Other - Org Name:WINTER SPRINGS SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-316-4615
Mailing Address - Street 1:5942 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5035
Mailing Address - Country:US
Mailing Address - Phone:321-316-4615
Mailing Address - Fax:321-316-4619
Practice Address - Street 1:5942 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5035
Practice Address - Country:US
Practice Address - Phone:321-316-4615
Practice Address - Fax:321-316-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH276633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145269OtherPK