Healthcare Provider Details

I. General information

NPI: 1669667424
Provider Name (Legal Business Name): EVERWELL SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 N DAVIS HWY
PENSACOLA FL
32504-6957
US

IV. Provider business mailing address

6506 N DAVIS HWY
PENSACOLA FL
32504-6957
US

V. Phone/Fax

Practice location:
  • Phone: 850-473-9190
  • Fax: 850-473-9935
Mailing address:
  • Phone: 850-473-9190
  • Fax: 850-473-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19748
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON CONTI
Title or Position: PIC
Credential: PHARMD
Phone: 850-712-7659