Provider Demographics
NPI:1487905840
Name:EAGLE PHARMACY LLC
Entity type:Organization
Organization Name:EAGLE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:863-873-0888
Mailing Address - Street 1:350 EAGLES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2999
Mailing Address - Country:US
Mailing Address - Phone:855-748-2663
Mailing Address - Fax:863-279-1293
Practice Address - Street 1:350 EAGLES LANDING DR.
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2899
Practice Address - Country:US
Practice Address - Phone:855-748-2663
Practice Address - Fax:863-686-5682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLENTERPRISES USA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
3336M0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy