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General NPI Number Information
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NPI Number | 1538248562
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Entity Type | Organization
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Legal Business Name | PARK AVENUE PHARMACY, INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 5440 DOGWOOD DR
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City | MILTON
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State | FL
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Zip | 32570-3700
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Country | US
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Telephone | 850-623-2222
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Fax | 850-981-9445
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Provider Business Mailing Address
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Address Line | 5440 DOGWOOD DR
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City | MILTON
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State | FL
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Zip | 32570-3700
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Country | US
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Telephone | 850-623-2222
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Fax | 850-981-9445
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRACEY PERRY CHASTAIN
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Credential | RPH
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Telephone | 850-623-2222
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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 | PH20089
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License Number State | FL
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