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General NPI Number Information
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NPI Number | 1063497972
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Entity Type | Organization
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Legal Business Name | VERNON DISCOUNT DRUG INC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3248 MAIN ST
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City | VERNON
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State | FL
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Zip | 32462-2223
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Country | US
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Telephone | 850-535-2803
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Fax | 850-535-2803
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | VERNON
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State | FL
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Zip | 32462-0505
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Country | US
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Telephone | 850-535-2803
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Fax | 850-535-0150
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MR. JACK GARY PAUL I
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Credential |
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Telephone | 850-535-2803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH11020
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License Number State | FL
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