Provider Demographics
NPI:1336405109
Name:STAYWELL PHARMACY INC.
Entity Type:Organization
Organization Name:STAYWELL PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:VAZHAYIL
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-378-4548
Mailing Address - Street 1:10112 US HWY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668
Mailing Address - Country:US
Mailing Address - Phone:727-378-4548
Mailing Address - Fax:727-378-4533
Practice Address - Street 1:10112 US HWY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668
Practice Address - Country:US
Practice Address - Phone:727-378-4548
Practice Address - Fax:727-378-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy