Provider Demographics
NPI:1821033572
Name:PACIFICO NATIONAL II INC
Entity type:Organization
Organization Name:PACIFICO NATIONAL II INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-445-2356
Mailing Address - Street 1:2275 S BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5305
Mailing Address - Country:US
Mailing Address - Phone:800-770-2990
Mailing Address - Fax:800-992-1322
Practice Address - Street 1:2275 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:800-770-2990
Practice Address - Fax:800-992-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAS032OtherMEDICARE-FIRST COAST SERVICE OPTIONS, INC.