Annalice LLC
Organization Active NPI Community/Retail Pharmacy · Bushnell, FL
NPI 1083848865 · NPPES record last updated Mar 1, 2017
Key facts
- NPI
- 1083848865
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PH24029 (FL)
- Legal business name
- ANNALICE LLC
- Practice address
- 115 W Belt Ave
Bushnell, FL 33513-5101 - Phone
- (352) 793-3100
- Fax
- (352) 793-3106
- NPI assigned
- May 8, 2009
- Organization subpart
- No
Authorized official
- Name
- Nelson Ohihoin
- Title
- Ceo
- Phone
- (727) 534-1318
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Annalice LLC
Locations
115 W Belt Ave
Bushnell, FL 33513
Phone (352) 793-3100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PH24029 | FL | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2120290 | Other | PK | |
| 001215500 | Medicaid | FL |
Other names
- Pegasus Rx Pharmacy
Other providers in Bushnell, FL
- Mahmud U Ahmed
- Symlene Alummoottil
- Amy'S Caring Hands
- Deonna Andrews
- Shannon Lee Jett Berry
- Kurt Neal Blackman
- Kattia Blanco
- Blessed at Home LLC
- Mary Hyacinth Bodenheimer
All providers in Bushnell, FL · Community/Retail Pharmacy in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.