=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114305810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECONOMY DRUG STORE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2015
-----------------------------------------------------
Last Update Date | 05/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 N MACOMB ST
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-224-5397
-----------------------------------------------------
Fax | 850-224-3900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 N MACOMB ST
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-224-5397
-----------------------------------------------------
Fax | 850-224-3900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/PHARMACIST
-----------------------------------------------------
Name | MRS. ALEXIS ROBERTS MCMILLAN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 850-224-5397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1460
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------