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General NPI Number Information
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NPI Number | 1396171492
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Entity Type | Organization
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Legal Business Name | CENTRAL FL PHARMACY CORP.
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 1219 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32803-4701
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Country | US
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Telephone | 407-898-0055
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Fax | 407-898-7787
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Provider Business Mailing Address
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Address Line | 1219 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32803-4701
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Country | US
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Telephone | 407-898-0055
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Fax | 407-898-7787
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. QUANLE PHAM YOAKUM
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Credential | PHARMD., RPH.
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Telephone | 407-898-0055
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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 | PH26790
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License Number State | FM
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