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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1235824426
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	:
Fax Number	:

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	:

Authorized Official
Title or Position	:	PHARMACY TECH
Name	:	MISS BILLIE KINNEY
Credential	:
Telephone Number	:	386-758-6770

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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