Provider Demographics
NPI:1457652257
Name:MILE STRETCH LLC
Entity Type:Organization
Organization Name:MILE STRETCH LLC
Other - Org Name:RAYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-945-7297
Mailing Address - Street 1:1936 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-5539
Mailing Address - Country:US
Mailing Address - Phone:727-945-7297
Mailing Address - Fax:727-945-8600
Practice Address - Street 1:1936 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5539
Practice Address - Country:US
Practice Address - Phone:727-945-7297
Practice Address - Fax:727-945-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25007333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy