Healthcare Provider Details

I. General information

NPI: 1437245990
Provider Name (Legal Business Name): CONSOLIDATED PHARMACY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 PARK STREET
JACKSONVILLE FL
32204-4519
US

IV. Provider business mailing address

2651 PARK STREET
JACKSONVILLE FL
32204-4519
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-2448
  • Fax: 904-387-0153
Mailing address:
  • Phone: 904-387-2448
  • Fax: 904-387-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH-0009430
License Number StateFL

VIII. Authorized Official

Name: DONNIE ROMINE
Title or Position: SYSTEM COO
Credential:
Phone: 904-308-1290