Provider Demographics
NPI:1750459020
Name:PINE HILLS PHARMACY, INC
Entity Type:Organization
Organization Name:PINE HILLS PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:THI NGOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-896-3434
Mailing Address - Street 1:1210 E COLONIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4727
Mailing Address - Country:US
Mailing Address - Phone:407-896-3434
Mailing Address - Fax:
Practice Address - Street 1:1210 E COLONIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4727
Practice Address - Country:US
Practice Address - Phone:407-896-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 154723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy