Provider Demographics
NPI:1992002612
Name:PICENTI LLC
Entity Type:Organization
Organization Name:PICENTI LLC
Other - Org Name:COUNTY LINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-244-3670
Mailing Address - Street 1:11147 COUNTY LINE RD
Mailing Address - Street 2:101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609
Mailing Address - Country:US
Mailing Address - Phone:727-244-3670
Mailing Address - Fax:352-340-5973
Practice Address - Street 1:11147 COUNTY LINE RD
Practice Address - Street 2:101
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5619
Practice Address - Country:US
Practice Address - Phone:727-244-3670
Practice Address - Fax:352-340-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 420243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy