Radiance Enterprises Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH25415 Issued in FL

Legal business name

RADIANCE ENTERPRISES INC

Doing business as

Bushnell Pharmacy

Practice address

417 N West St
Bushnell, FL 33513-6021

Phone

(352) 569-5800

Fax

(352) 569-5802

NPI assigned

Jun 2, 2011

Last updated

Jun 8, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack DiamondNPI 1184152886

Title

Pharmacy Manager

Phone

(352) 569-5800

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Bushnell Pharmacy Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack Diamond, RPH

  • Pharmacist
  • Wesley Chapel, FL
  • NPI 1184152886
  NPD Authorized official
• Nwando Nwanna, PHARMD

  • Pharmacist
  • Dunedin, FL
  • NPI 1518590967
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1134413560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 N WEST ST",
            "city": "BUSHNELL",
            "state": "FL",
            "postal_code": "335136021",
            "telephone_number": "352-569-5800",
            "fax_number": "352-569-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 N WEST ST",
            "city": "BUSHNELL",
            "state": "FL",
            "postal_code": "335136021",
            "telephone_number": "352-569-5800",
            "fax_number": "352-569-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANCE ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "352-569-5800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH25415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003766101",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003766100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130577",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bushnell Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Bushnell, FL
• Providers in Bushnell, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.