Provider Demographics
NPI:1972884203
Name:PINNACLE PHARMACY INC
Entity type:Organization
Organization Name:PINNACLE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PINNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:386-313-5996
Mailing Address - Street 1:80 PINNACLES DR STE 900
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2915
Mailing Address - Country:US
Mailing Address - Phone:386-313-5995
Mailing Address - Fax:386-313-5996
Practice Address - Street 1:80 PINNACLES DR STE 900
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2915
Practice Address - Country:US
Practice Address - Phone:386-313-5995
Practice Address - Fax:386-313-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL256383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0042810000Medicaid
2131688OtherPK