=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639910268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIGHTINGALE PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2024
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9100 WHITE BLUFF RD STE 604
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31406-4674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-856-2365
-----------------------------------------------------
Fax | 912-856-2408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9100 WHITE BLUFF RD STE 604
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31406-4674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-856-2365
-----------------------------------------------------
Fax | 912-856-2408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | ALEXANDRA NICOLE CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-433-8581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------