Healthcare Provider Details

I. General information

NPI: 1023090362
Provider Name (Legal Business Name): SENIOR CARE PHARMACY OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S PIPKIN RD STE 208
LAKELAND FL
33811-1699
US

IV. Provider business mailing address

931 FAIRFAX PARK ATTN: LYNN CONNOR
TUSCALOOSA AL
35406-2805
US

V. Phone/Fax

Practice location:
  • Phone: 863-577-1440
  • Fax:
Mailing address:
  • Phone: 205-310-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH18723
License Number StateFL

VIII. Authorized Official

Name: ALAN OBRINGER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 863-577-1440