Healthcare Provider Details

I. General information

NPI: 1679138432
Provider Name (Legal Business Name): PANCARE OF FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 10TH ST
MALONE FL
32445-3429
US

IV. Provider business mailing address

5336 10TH ST
MALONE FL
32445-3429
US

V. Phone/Fax

Practice location:
  • Phone: 850-569-2021
  • Fax: 850-569-2022
Mailing address:
  • Phone: 850-569-2021
  • Fax: 850-569-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES FLOWERS
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 850-818-0455