Provider Demographics
NPI:1649687302
Name:ORLANDO COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:ORLANDO COMPOUNDING PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:APURV
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-614-1737
Mailing Address - Street 1:1201 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4380
Mailing Address - Country:US
Mailing Address - Phone:407-614-1737
Mailing Address - Fax:407-614-1740
Practice Address - Street 1:1201 WINTER GARDEN VINELAND RD
Practice Address - Street 2:SUITE 7
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4380
Practice Address - Country:US
Practice Address - Phone:407-614-1737
Practice Address - Fax:407-614-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty