=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376750679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORANGE COUNTY MEDICAL CLINIC PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S WESTMORELAND DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32805-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-836-7160
-----------------------------------------------------
Fax | 407-836-9222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 S WESTMORELAND DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32805-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-836-7160
-----------------------------------------------------
Fax | 407-836-9222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | DR. SHARI HOPWOOD
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 407-836-9225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number | PH1115
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------