MEDICARE: CONSOLIDATED PHARMACY SERVICES, 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	3336L0003X	Long Term Care Pharmacy	PH-0009430	FL
2	3336C0003X	Community/Retail Pharmacy

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	PH-0009430	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1437245990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSOLIDATED PHARMACY SERVICES, INC

Provider Business Mailing Address
First Line	:	2651 PARK STREET
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4519
Country	:	US
Telephone Number	:	904-387-2448
Fax Number	:	904-387-0153

Provider Business Practice Location Address
First Line	:	2651 PARK STREET
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4519
Country	:	US
Telephone Number	:	904-387-2448
Fax Number	:	904-387-0153

Authorized Official
Title or Position	:	SYSTEM COO
Name	:	DONNIE ROMINE
Credential	:
Telephone Number	:	904-308-1290

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/08/2015

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