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General NPI Number Information
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NPI Number | 1619458981
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Entity Type | Organization
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Legal Business Name | SIMPLYWELL SPECIALTY PHARMACY LP
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 463128 STATE ROAD 200
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City | YULEE
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State | FL
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Zip | 32097-5554
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Country | US
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Telephone | 904-468-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 463128 STATE ROAD 200
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City | YULEE
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State | FL
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Zip | 32097-5554
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Country | US
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Telephone | 904-468-3020
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Fax | 904-849-1627
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MADISON CLAYTON
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Credential | PHARMD
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Telephone | 904-468-3020
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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 | 31635
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License Number State | FL
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