Healthcare Provider Details

I. General information

NPI: 1235631912
Provider Name (Legal Business Name): CPMS FLORIDA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 OLD WINTER GARDEN RD
OCOEE FL
34761-2995
US

IV. Provider business mailing address

11 BISHOP RD
OXFORD CT
06478-1597
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0641
  • Fax: 407-656-0643
Mailing address:
  • Phone: 203-518-1146
  • Fax: 203-828-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH31343
License Number StateFL

VIII. Authorized Official

Name: SCOTT WOLAK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 203-518-1146