Provider Demographics
NPI:1417968900
Name:VOLEL PROFESSIONAL PHARMACIST ASSOCIATION
Entity Type:Organization
Organization Name:VOLEL PROFESSIONAL PHARMACIST ASSOCIATION
Other - Org Name:PHARMACY ONE PRO SPECIALTY CARE PHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-401-9300
Mailing Address - Street 1:65 3RD ST NW
Mailing Address - Street 2:STE 59
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4670
Mailing Address - Country:US
Mailing Address - Phone:863-401-9300
Mailing Address - Fax:863-401-9330
Practice Address - Street 1:65 3RD ST NW
Practice Address - Street 2:STE 59
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4670
Practice Address - Country:US
Practice Address - Phone:863-401-9300
Practice Address - Fax:863-401-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH196203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026551900Medicaid
2006307OtherPK