Provider Demographics
NPI:1508218496
Name:DR. MARK BORNSTEIN WC PHARMACY
Entity Type:Organization
Organization Name:DR. MARK BORNSTEIN WC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-310-8093
Mailing Address - Street 1:701 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4623
Mailing Address - Country:US
Mailing Address - Phone:407-310-8093
Mailing Address - Fax:407-857-3893
Practice Address - Street 1:701 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4623
Practice Address - Country:US
Practice Address - Phone:407-310-8093
Practice Address - Fax:407-857-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1420332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site