Healthcare Provider Details

I. General information

NPI: 1134005796
Provider Name (Legal Business Name): FLORIDA DEPT OF CORRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 S. CR 231 RECEPTION AND MEDICAL CENTER
LAKE BUTLER FL
32054
US

IV. Provider business mailing address

501 S. CALHOUN STREET FLORIDA DEPT OF CORRECTIONS ATTN: PHARMACY SERVICES
TALLAHASSEE FL
32399
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-7241
  • Fax:
Mailing address:
  • Phone: 850-717-3287
  • Fax:

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. RENEA MARCANO
Title or Position: BUREAU CHIEF OF PHARMACEUTICAL SERV
Credential: PHARMD
Phone: 850-717-3287