MEDICARE: NORTH FLORIDA PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	PH15487	FL
2	3336C0003X	Community/Retail Pharmacy	PH15487	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1081025	OTHER	OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194734038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA PHARMACY, INC.

Provider Business Mailing Address
First Line	:	3718 W US HIGHWAY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4897
Country	:	US
Telephone Number	:	386-755-9300
Fax Number	:	386-755-9371

Provider Business Practice Location Address
First Line	:	3718 W US HIGHWAY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4897
Country	:	US
Telephone Number	:	386-755-9300
Fax Number	:	386-755-9371

Authorized Official
Title or Position	:	OWNER
Name	:	JOEL ROSENFELD
Credential	:
Telephone Number	:	386-758-9300

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	11/03/2020

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