Healthcare Provider Details

I. General information

NPI: 1366441842
Provider Name (Legal Business Name): PHARMACY INVESTMENT COORDINATORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CECIL G COSTIN SR BLVD
PORT ST JOE FL
32456-1905
US

IV. Provider business mailing address

PO BOX 72148
ALBANY GA
31708-2148
US

V. Phone/Fax

Practice location:
  • Phone: 850-227-7099
  • Fax: 850-227-1909
Mailing address:
  • Phone: 229-435-4571
  • Fax: 229-435-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19805
License Number StateFL

VIII. Authorized Official

Name: THOMAS SHARPE
Title or Position: OWNER
Credential:
Phone: 229-435-4571