Provider Demographics
NPI:1578587234
Name:PMSI INC
Entity Type:Organization
Organization Name:PMSI INC
Other - Org Name:PMSI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-318-6844
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:DEPT 0570
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:813-318-6758
Mailing Address - Fax:813-627-2502
Practice Address - Street 1:4502 E WOODLAND CORP. BLVD.
Practice Address - Street 2:STE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-318-6758
Practice Address - Fax:813-627-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
FLPH198023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1066124OtherNCPDP PROVIDER IDENTIFICATION NUMBER