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General NPI Number Information
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NPI Number | 1275659757
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Entity Type | Organization
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Legal Business Name | L A D S CO. OF NORTH FLORIDA
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 140 SW RANGE AVE
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City | MADISON
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State | FL
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Zip | 32340-2457
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Country | US
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Telephone | 850-973-2222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 509
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City | MADISON
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State | FL
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Zip | 32341-0509
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Country | US
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Telephone | 850-973-2222
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CHARLES LEE NORRIS
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Credential |
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Telephone | 850-973-2222
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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 | PH12077
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License Number State | FL
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