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General NPI Number Information
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NPI Number | 1235631912
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Entity Type | Organization
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Legal Business Name | CPMS FLORIDA PHARMACY LLC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 2775 OLD WINTER GARDEN RD
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City | OCOEE
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State | FL
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Zip | 34761-2995
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Country | US
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Telephone | 407-656-0641
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Fax | 407-656-0643
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Provider Business Mailing Address
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Address Line | 11 BISHOP RD
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City | OXFORD
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State | CT
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Zip | 06478-1597
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Country | US
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Telephone | 203-518-1146
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Fax | 203-828-6236
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | SCOTT WOLAK
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Credential |
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Telephone | 203-518-1146
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH31343
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License Number State | FL
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