Provider Demographics
NPI:1124114210
Name:ORLANDO PHARMACY INC
Entity type:Organization
Organization Name:ORLANDO PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SICINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-898-1331
Mailing Address - Street 1:2909 N ORANGE AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4639
Mailing Address - Country:US
Mailing Address - Phone:407-898-1331
Mailing Address - Fax:407-895-1672
Practice Address - Street 1:2909 N ORANGE AVE STE 112
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4639
Practice Address - Country:US
Practice Address - Phone:407-898-1331
Practice Address - Fax:407-895-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
COOSP.0007037333600000X
FLPH11183336C0003X
SC176213336C0003X
TX315123336C0003X
VA02140019503336C0003X
IL0540207223336C0003X
GAPHNR0013123336C0003X
OH022816000-023336C0003X
MO20170339173336C0003X
UT10518152-17083336C0003X
AZY0074323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007523OtherPK
FL100689400Medicaid
FL100689400Medicaid