Healthcare Provider Details

I. General information

NPI: 1760418933
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST BLDG 1235
CHATTAHOOCHEE FL
32324-1107
US

IV. Provider business mailing address

PO BOX 1000
CHATTAHOOCHEE FL
32324-1000
US

V. Phone/Fax

Practice location:
  • Phone: 850-663-7675
  • Fax: 850-663-7385
Mailing address:
  • Phone: 850-663-7675
  • Fax: 850-663-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPH6234
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TONJA MCELVIN
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 850-663-7675