Provider Demographics
NPI:1891321089
Name:EAGLE PHARMACY LLC
Entity Type:Organization
Organization Name:EAGLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:863-825-4102
Mailing Address - Street 1:330 EAGLES LANDING DR STE 172
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3041
Mailing Address - Country:US
Mailing Address - Phone:888-920-0527
Mailing Address - Fax:877-816-5523
Practice Address - Street 1:330 EAGLES LANDING DR STE 172
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3041
Practice Address - Country:US
Practice Address - Phone:888-920-0527
Practice Address - Fax:877-816-5523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy