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General NPI Number Information
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NPI Number | 1154426070
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Entity Type | Organization
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Legal Business Name | SANTA ROSA PHARMACY, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 19 TOWN CENTER LOOP UNIT 1A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-622-3313
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Fax | 850-622-3255
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Provider Business Mailing Address
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Address Line | 19 TOWN CENTER LOOP UNIT 1A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-622-3313
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Fax | 850-622-3255
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Authorized Official
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Title or Position | PRES.
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Name | MR. GEORGE THOMAS FLOWERS
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Credential | RPH
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Telephone | 850-622-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH19512
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License Number State | FL
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