Annalice LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH24481 Issued in FL

Legal business name

ANNALICE LLC

Practice address

1992 Alt US Highway 19
Tarpon Springs, FL 34689

Phone

(727) 938-6400

Fax

(727) 938-6433

NPI assigned

Mar 11, 2010

Organization subpart

No

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

Authorized official

Name

Nelson Ohihoin

Title

President

Phone

(727) 534-1318

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Pegasus Rx Pharmacy Doing business as

Tax ID family

Annalice LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Annalice LLC

  • Community/Retail Pharmacy
  • Bushnell, FL
  • NPI 1083848865
  NPD tax ID
• Annalice LLC

  • Pharmacy
  • Port Richey, FL
  • NPI 1629398003
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Munavvara Binti Murusal Ibrahim, RPH

  • Pharmacist
  • Tarpon Springs, FL
  • NPI 1497049530
  NPD (past)

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1649593179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1992 ALT US HIGHWAY 19",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "34689",
            "telephone_number": "727-938-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1992 ALT US HIGHWAY 19",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "34689",
            "telephone_number": "727-938-6400",
            "fax_number": "727-938-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNALICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "OHIHOIN",
        "authorized_official_first_name": "NELSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "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": "PH24481",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002335600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2124203",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pegasus Rx Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Tarpon Springs, FL
• Community/Retail Pharmacy in Florida

• 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.

Verify at the official NPI Registry.