Healthcare Provider Details

I. General information

NPI: 1295154185
Provider Name (Legal Business Name): PUTNAM COMMUNITY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ZEAGLER DR
PALATKA FL
32177-3810
US

IV. Provider business mailing address

611 ZEAGLER DR
PALATKA FL
32177-3810
US

V. Phone/Fax

Practice location:
  • Phone: 386-326-8450
  • Fax: 386-326-8484
Mailing address:
  • Phone: 386-326-8450
  • Fax: 386-326-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPH17363
License Number StateFL

VIII. Authorized Official

Name: GAIL KING
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 386-326-8451