Provider Demographics
NPI:1992892830
Name:PEE JAY INC
Entity type:Organization
Organization Name:PEE JAY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-892-1060
Mailing Address - Street 1:2521 13TH ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:ST CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-892-1060
Mailing Address - Fax:407-892-7339
Practice Address - Street 1:2521 13TH ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4119
Practice Address - Country:US
Practice Address - Phone:407-892-1060
Practice Address - Fax:407-892-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336S0011X
FLPH173113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013974OtherPK
FL020095900Medicaid
0316170001Medicare NSC