=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518051093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HRS CITRUS COUNTY HEALTH DEPT. PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2804 MARC KNIGHTON CT
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-527-0068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2804 MARC KNIGHTON CT BIN 14
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-249-9258
-----------------------------------------------------
Fax | 352-527-3013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNTY HEALTH DEPARTMENT ADMINISTRA
-----------------------------------------------------
Name | DR. TERESA L. GOODMAN
-----------------------------------------------------
Credential | ARNP, PHD
-----------------------------------------------------
Telephone | 352-527-0068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332000000X
-----------------------------------------------------
Taxonomy Name | Military/U.S. Coast Guard Pharmacy
-----------------------------------------------------
License Number | PH 13705
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24681
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------