Provider Demographics
NPI:1245631936
Name:A & B PHARMACEUTICAL SERVICES INC
Entity type:Organization
Organization Name:A & B PHARMACEUTICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BISHASWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHADEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-569-6056
Mailing Address - Street 1:4750 E MOODY BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-7709
Mailing Address - Country:US
Mailing Address - Phone:386-313-6959
Mailing Address - Fax:
Practice Address - Street 1:4750 E MOODY BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7710
Practice Address - Country:US
Practice Address - Phone:386-313-6959
Practice Address - Fax:386-313-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH282423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147811OtherPK