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General NPI Number Information
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NPI Number | 1083809883
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA RECEPTION CENTER
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 7765 S COUNTY ROAD 231 DEPT OF CORRECTIONS
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City | LAKE BUTLER
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State | FL
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Zip | 32054-5721
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Country | US
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Telephone | 386-496-6532
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Fax | 386-496-6081
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Provider Business Mailing Address
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Address Line | PO BOX 628
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City | LAKE BUTLER
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State | FL
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Zip | 32054-0628
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Country | US
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Telephone | 386-496-6532
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Fax | 386-496-6081
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | SUSAN MOULDER
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Credential | RPH
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Telephone | 386-496-6534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | PH2387
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License Number State | FL
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