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General NPI Number Information
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NPI Number | 1538187539
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Entity Type | Organization
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Legal Business Name | MAYO FAMILY PHARMACY, INC.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 294 W MAIN ST SUITE 1
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City | MAYO
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State | FL
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Zip | 32066
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Country | US
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Telephone | 386-294-3500
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Fax | 386-294-3482
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Provider Business Mailing Address
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Address Line | PO BOX 405
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City | MAYO
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State | FL
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Zip | 32066
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Country | US
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Telephone | 386-294-3500
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Fax | 386-294-3482
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Authorized Official
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Title or Position | PHARMACY MANAGER OWNER
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Name | MR. IRA L RILEY JR.
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Credential | RPH
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Telephone | 386-294-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH18715
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH18715
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License Number State | FL
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