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General NPI Number Information
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NPI Number | 1841532108
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Entity Type | Organization
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Legal Business Name | MAGNOLIA PHARMACY LLC
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 12525 CURLEY ST
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City | SAN ANTONIO
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State | FL
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Zip | 33576-7094
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Country | US
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Telephone | 352-588-3330
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Fax | 352-588-3337
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Provider Business Mailing Address
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Address Line | 12525 CURLEY ST
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City | SAN ANTONIO
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State | FL
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Zip | 33576-7094
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Country | US
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Telephone | 352-588-3330
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Fax | 352-588-3337
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | SHANNON CORKREAN
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Credential |
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Telephone | 352-409-1061
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH26768
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License Number State | FL
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