Provider Demographics
NPI:1730286063
Name:PINE HILLS DRUGS INC
Entity Type:Organization
Organization Name:PINE HILLS DRUGS INC
Other - Org Name:PINE HILLS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MBIONWU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-291-1236
Mailing Address - Street 1:5600 W COLONIAL DR STE 316A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7646
Mailing Address - Country:US
Mailing Address - Phone:407-291-1236
Mailing Address - Fax:407-291-1797
Practice Address - Street 1:5600 W COLONIAL DR STE 316A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7646
Practice Address - Country:US
Practice Address - Phone:407-291-1236
Practice Address - Fax:407-291-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
FLPH193733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026164500Medicaid
2015749OtherPK
4941960001Medicare NSC