Active NPI
Annalice LLC
Doing business as Pegasus Rx Pharmacy
- Community/Retail Pharmacy
- Bushnell, FL
National Provider Identifier
1083848865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH24029
- Legal business name
- ANNALICE LLC
- Doing business as
- Pegasus Rx Pharmacy
- Practice address
- 115 W Belt Ave
Bushnell, FL 33513-5101 - Phone
- (352) 793-3100
- Fax
- (352) 793-3106
- NPI assigned
- May 8, 2009
- Last updated
- Mar 1, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nelson Ohihoin
- Title
- Ceo
- Phone
- (727) 534-1318
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PH24029 | FL | Primary |
Addresses
Primary practice location
115 W Belt Ave
Bushnell, FL 33513-5101
Mailing address
115 W Belt Ave
Bushnell, FL 33513-5101
Phone (352) 793-3100
Other names 1
- Pegasus Rx Pharmacy
National Provider Directory
National Provider Directory- Tax ID family
- Annalice LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
Locations
115 W Belt Ave
Bushnell, FL 33513
Phone (352) 793-3100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241740800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488326400000",
"number": "1083848865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 W BELT AVE",
"city": "BUSHNELL",
"state": "FL",
"postal_code": "335135101",
"telephone_number": "352-793-3100",
"fax_number": "352-793-3106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 W BELT AVE",
"city": "BUSHNELL",
"state": "FL",
"postal_code": "335135101",
"telephone_number": "352-793-3100",
"fax_number": "352-793-3106"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANNALICE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-05-08",
"last_updated": "2017-03-01",
"status": "A",
"authorized_official_last_name": "OHIHOIN",
"authorized_official_first_name": "NELSON",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "727-534-1318"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "FL",
"license": "PH24029",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Pegasus Rx Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bushnell, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.