Healthcare Provider Details

I. General information

NPI: 1396884342
Provider Name (Legal Business Name): SACRED HEART OUT PATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 N 9TH AVE STE 1137
PENSACOLA FL
32504-8756
US

IV. Provider business mailing address

5149 N 9TH AVE STE 1137
PENSACOLA FL
32504-8756
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7137
  • Fax: 850-416-6122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH0012690
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOEY HEART
Title or Position: MANAGER
Credential:
Phone: 850-416-7137