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General NPI Number Information
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NPI Number | 1699227025
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Entity Type | Organization
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Legal Business Name | ORANGE PARK PHARMACY INC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1992 KINGSLEY AVE SUITE B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4442
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Country | US
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Telephone | 904-579-3027
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Fax | 904-579-4551
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Provider Business Mailing Address
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Address Line | 1992 KINGSLEY AVE SUITE B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4442
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Country | US
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Telephone | 904-579-3027
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Fax | 904-579-4551
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Authorized Official
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Title or Position | PHARMACY MANAGER/OWNER
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Name | ABDALLA MOHAMED
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Credential | PHARMD
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Telephone | 904-579-3027
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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 | PH30423
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License Number State | FL
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