Provider Demographics
NPI:1700233368
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:OWNER 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 1:6472 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32534
Mailing Address - Country:US
Mailing Address - Phone:850-564-0880
Mailing Address - Fax:850-564-0884
Practice Address - Street 1:6472 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4560
Practice Address - Country:US
Practice Address - Phone:850-564-0880
Practice Address - Fax:850-564-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH299703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160230OtherPK