MEDICARE: NORTH FLORIDA PHARMACY OF FORT WHITE INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	PH22706	FL
2	3336C0003X	Community/Retail Pharmacy	PH22706	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043414782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA PHARMACY OF FORT WHITE INC

Provider Business Mailing Address
First Line	:	7729 SOUTHWEST US HIGHWAY 27
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038
Country	:	US
Telephone Number	:	386-497-2580
Fax Number	:	386-497-4227

Provider Business Practice Location Address
First Line	:	7729 SW US HIGHWAY 27
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038-3508
Country	:	US
Telephone Number	:	386-497-2580
Fax Number	:	386-497-4227

Authorized Official
Title or Position	:	CO-OWNER, PHARMACY MANAGER
Name	:	DR. KATHLEEN MARSHALL
Credential	:	PHARM.D., R.PH.
Telephone Number	:	352-871-0819

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	08/13/2010

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