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General NPI Number Information
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NPI Number | 1013913680
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Entity Type | Organization
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Legal Business Name | EXTENDED CARE PHARMACY, INC.
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 6400 CRILL AVE
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City | PALATKA
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State | FL
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Zip | 32177-3876
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Country | US
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Telephone | 386-325-5505
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Fax | 386-328-9393
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Provider Business Mailing Address
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Address Line | 6400 CRILL AVE
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City | PALATKA
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State | FL
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Zip | 32177-3876
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Country | US
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Telephone | 386-325-5505
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Fax | 386-328-9393
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MARK CASEY PHILLIPS
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Credential |
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Telephone | 386-325-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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