Healthcare Provider Details

I. General information

NPI: 1720055775
Provider Name (Legal Business Name): ENSLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8814 N PALAFOX ST # C
PENSACOLA FL
32534-3029
US

IV. Provider business mailing address

5740 WESTMONT RD
MILTON FL
32583-2333
US

V. Phone/Fax

Practice location:
  • Phone: 850-473-0428
  • Fax: 850-473-3958
Mailing address:
  • Phone: 850-982-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH16642
License Number StateFL

VIII. Authorized Official

Name: PRESTON MCDONALD
Title or Position: PRESIDENT
Credential: BPHARM
Phone: 850-473-0428