MEDICARE: LAURELPHARM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PH19549	FL
2	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1094781	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1013011063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURELPHARM LLC

Provider Business Mailing Address
First Line	:	440 N COVE BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 N COVE BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3726
Country	:	US
Telephone Number	:	850-785-2104
Fax Number	:	800-882-3241

Authorized Official
Title or Position	:	DIVISION PRES
Name	:	JEFFREY WOODSIDE
Credential	:	RPH
Telephone Number	:	407-571-1550

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	09/11/2025

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Directions to “LAURELPHARM LLC ” Practice Location

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