MEDICARE: PRESCRIPTION PLACE OF DEFUNIAK SPRINGS 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	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH21644	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	2005427	OTHER		PK

General Provider Information

NPI Number	:	1457370520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION PLACE OF DEFUNIAK SPRINGS INC

Provider Business Mailing Address
First Line	:	1337 US HIGHWAY 90 W
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-1470
Country	:	US
Telephone Number	:	850-892-6898
Fax Number	:	850-892-6899

Provider Business Practice Location Address
First Line	:	1337 US HIGHWAY 90 W
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-1470
Country	:	US
Telephone Number	:	850-892-6898
Fax Number	:	850-892-6899

Authorized Official
Title or Position	:	PHARMACIST
Name	:	SHANE ABBOTT
Credential	:
Telephone Number	:	850-892-6898

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/10/2015

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Directions to “PRESCRIPTION PLACE OF DEFUNIAK SPRINGS INC ” Practice Location

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