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General NPI Number Information
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NPI Number | 1295154185
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Entity Type | Organization
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Legal Business Name | PUTNAM COMMUNITY MEDICAL CENTER LLC
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 611 ZEAGLER DR
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City | PALATKA
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State | FL
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Zip | 32177-3810
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Country | US
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Telephone | 386-326-8450
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Fax | 386-326-8484
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Provider Business Mailing Address
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Address Line | 611 ZEAGLER DR
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City | PALATKA
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State | FL
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Zip | 32177-3810
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Country | US
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Telephone | 386-326-8450
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Fax | 386-326-8484
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | GAIL KING
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Credential |
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Telephone | 386-326-8451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | PH17363
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License Number State | FL
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