MEDICARE: FLORENCE PHARMACY 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
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1669192761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORENCE PHARMACY LLC

Provider Business Mailing Address
First Line	:	1017 US HIGHWAY 80 E STE E
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-9532
Country	:	US
Telephone Number	:	912-348-1811
Fax Number	:	912-988-3097

Provider Business Practice Location Address
First Line	:	1017 US HIGHWAY 80 E STE 10
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-9533
Country	:	US
Telephone Number	:	912-348-1811
Fax Number	:	912-988-3097

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMY MICHAEL SIMMONS
Credential	:	PHARMD
Telephone Number	:	843-729-5583

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	12/07/2025

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Directions to “FLORENCE PHARMACY LLC ” Practice Location

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