MEDICARE: NORTH FLORIDA PHARMACY OF HIGH 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	332B00000X	Durable Medical Equipment & Medical Supplies	PH23359	FL
2	332BX2000X	Oxygen Equipment & Supplies (DME)	PH23359	FL
3	3336C0003X	Community/Retail Pharmacy	PH23359	FL

General Provider Information

NPI Number	:	1649447699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA PHARMACY OF HIGH SPRINGS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 846
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32655-0846
Country	:	US
Telephone Number	:	386-454-1382
Fax Number	:	386-454-5734

Provider Business Practice Location Address
First Line	:	115 NW SANTA FE BLVD
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-4301
Country	:	US
Telephone Number	:	386-454-1382
Fax Number	:	386-454-5734

Authorized Official
Title or Position	:	PRESIDENT/PHARMACY MANAGER
Name	:	MR. JOSEPH GERALD CAIN
Credential	:	PS10408
Telephone Number	:	386-454-1382

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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