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General NPI Number Information
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NPI Number | 1245283423
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Entity Type | Organization
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Legal Business Name | SEASIDE FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 4075 A1A S STE 102
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6773
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Country | US
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Telephone | 904-461-3299
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Fax | 904-461-3277
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Provider Business Mailing Address
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Address Line | 4075 A1A S STE 102
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6773
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Country | US
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Telephone | 904-461-3299
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Fax | 904-461-3277
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Authorized Official
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Title or Position | CO OWNER
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Name | JAMES PENNINGTON
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Credential | RPH
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Telephone | 904-461-3299
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH21889
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License Number State | FL
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