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General NPI Number Information
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NPI Number | 1316098486
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD SPECIALTY PHARMACY
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21234 OLEAN BLVD SUITE 6
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6752
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Country | US
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Telephone | 941-255-3784
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Fax | 941-255-3724
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Provider Business Mailing Address
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Address Line | 21234 OLEAN BLVD SUITE 6
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6752
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Country | US
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Telephone | 941-255-3784
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Fax | 941-255-3724
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAN EDWARD FARRIS
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Credential | RPH.
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Telephone | 941-255-3784
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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 | PH19429
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License Number State | FL
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