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General NPI Number Information
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NPI Number | 1023263381
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Entity Type | Organization
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Legal Business Name | ATLANTIC MEDICATION MANAGEMENT SYSTEMS INC
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Dates
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Enumeration Date | 11/28/2008
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Last Update Date | 11/28/2008
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Provider Practice Location Address
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Address Line | 1545 TOWN PARK DR
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City | PORT ORANGE
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State | FL
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Zip | 32129-5274
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Country | US
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Telephone | 386-299-5087
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Fax | 386-672-9013
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Provider Business Mailing Address
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Address Line | 1545 TOWN PARK DR
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City | PORT ORANGE
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State | FL
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Zip | 32129-5274
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Country | US
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Telephone | 386-299-5087
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Fax | 386-672-9013
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Authorized Official
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Title or Position | TREASURER
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Name | MR. DENIS B GOUDREAU
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Credential | RPH
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Telephone | 386-672-9013
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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 | PS0020183
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License Number State | FL
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