Provider Demographics
NPI:1245625938
Name:PHARMACY 4 LESS LLC
Entity type:Organization
Organization Name:PHARMACY 4 LESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRYS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH CPH
Authorized Official - Phone:321-207-8438
Mailing Address - Street 1:805 DOUGLAS AVE STE 159
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:321-207-8438
Mailing Address - Fax:407-951-8174
Practice Address - Street 1:805 DOUGLAS AVE STE #159
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:321-207-8438
Practice Address - Fax:407-951-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28986333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016414900Medicaid