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General NPI Number Information
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NPI Number | 1770050965
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Entity Type | Organization
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Legal Business Name | OLD TOWN PHARMACY INC
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 26064 US- 19
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City | OLD TOWN
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State | FL
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Zip | 32680
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Country | US
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Telephone | 386-758-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 1756 SW BARNETT WAY
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City | LAKE CITY
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State | FL
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Zip | 32025-6953
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | TERRY HODGKINSON
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Credential |
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Telephone | 386-758-6770
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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 |
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License Number State |
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