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General NPI Number Information
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NPI Number | 1629227442
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF CHILDREN & FAMILES
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 7487 S STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-5451
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Country | US
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Telephone | 904-259-6211
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Fax | 904-259-6709
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Provider Business Mailing Address
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Address Line | 7487 S STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-5451
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Country | US
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Telephone | 904-259-6211
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Fax | 904-259-6709
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. TAN H PHAM
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Credential | PHARM.D.
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Telephone | 904-330-2011
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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