Provider Demographics
NPI:1417700550
Name:OVIEDO PHARMACY AND DRUG STORE LLC
Entity Type:Organization
Organization Name:OVIEDO PHARMACY AND DRUG STORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-977-9779
Mailing Address - Street 1:784 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8060
Mailing Address - Country:US
Mailing Address - Phone:407-977-9779
Mailing Address - Fax:407-977-0079
Practice Address - Street 1:784 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8060
Practice Address - Country:US
Practice Address - Phone:407-977-9779
Practice Address - Fax:407-977-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy