Provider Demographics
NPI:1538754916
Name:AT YOUR SERVICE PHARMACY
Entity type:Organization
Organization Name:AT YOUR SERVICE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALANTINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MORANCY-CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, BCMTMS, CPH
Authorized Official - Phone:561-319-5634
Mailing Address - Street 1:2002 SW GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1025
Mailing Address - Country:US
Mailing Address - Phone:305-528-6539
Mailing Address - Fax:
Practice Address - Street 1:692 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1835
Practice Address - Country:US
Practice Address - Phone:305-528-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No305S00000XManaged Care OrganizationsPoint of Service
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No335G00000XSuppliersMedical Foods Supplier