Provider Demographics
NPI:1871959296
Name:DRAGONFLY BOTANICA LLC
Entity type:Organization
Organization Name:DRAGONFLY BOTANICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIORGIANNI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:321-622-8155
Mailing Address - Street 1:6450 N WICKHAM RD
Mailing Address - Street 2:102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2036
Mailing Address - Country:US
Mailing Address - Phone:321-622-8155
Mailing Address - Fax:
Practice Address - Street 1:6450 N WICKHAM RD
Practice Address - Street 2:102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2036
Practice Address - Country:US
Practice Address - Phone:321-622-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy