Provider Information for 1053834267
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SPNN LLC
Other Names:Doing Business As:BE WELL PHARMACYOrganization Subpart: NO
NPI: 1053834267
Last Updated: 2018-08-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053834267 | ||||||||
| Enumeration Date | 2017-07-19 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: SHADY BASTA Title: OWNER Phone: 7273725600 | ||||||||
| Mailing Address | 5429 LITTLE RD NEW PORT RICHEY, FL 34655-1107 United States Phone: 727-372-5600 | Fax:727-372-5603 | ||||||||
| Primary Practice Address | 5429 LITTLE RD NEW PORT RICHEY, FL 34655 United States Phone: 717-507-0888 | Fax: | ||||||||
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