Provider Demographics
NPI:1427181999
Name:FLORIDA AVENUE PRESCRIPTIONS, INC.
Entity Type:Organization
Organization Name:FLORIDA AVENUE PRESCRIPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:PARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:209-576-7277
Mailing Address - Street 1:1541 FLORIDA AVE
Mailing Address - Street 2:SUITE P
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4429
Mailing Address - Country:US
Mailing Address - Phone:209-576-7277
Mailing Address - Fax:209-576-1220
Practice Address - Street 1:1541 FLORIDA AVE
Practice Address - Street 2:SUITE P
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4429
Practice Address - Country:US
Practice Address - Phone:209-576-7277
Practice Address - Fax:209-576-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY389423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy