Provider Demographics
NPI:1477095685
Name:SERVICE PRO PHARMACY LLC
Entity Type:Organization
Organization Name:SERVICE PRO PHARMACY LLC
Other - Org Name:SERVICE PRO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:VIATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-516-5886
Mailing Address - Street 1:4880 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8762
Mailing Address - Country:US
Mailing Address - Phone:850-995-9999
Mailing Address - Fax:850-995-0095
Practice Address - Street 1:4880 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8762
Practice Address - Country:US
Practice Address - Phone:850-995-9999
Practice Address - Fax:850-995-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL303723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165886OtherPK