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NPI Code Detail

MEDICARE: SOUTH WALTON PHARMACY LLC

MEDICARE: SOUTH WALTON 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
13336C0003XCommunity/Retail PharmacyPH25428FL
23336H0001XHome Infusion Therapy Pharmacy
33336S0011XSpecialty Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22130225OTHERPK

General Provider Information

NPI Number : 1942509401
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH WALTON PHARMACY LLC
Provider Business Mailing Address
First Line : 2050 W COUNTY HIGHWAY 30A
Second Line : M1-106
City : SANTA ROSA BEACH
State : FL
Zip : 32459-0187
Country : US
Telephone Number : 850-622-3313
Fax Number : 850-622-3255
Provider Business Practice Location Address
First Line : 2050 W COUNTY HIGHWAY 30A UNIT M1-106
Second Line :
City : SANTA ROSA BEACH
State : FL
Zip : 32459-0187
Country : US
Telephone Number : 850-622-3313
Fax Number : 850-622-3255
Authorized Official
Title or Position : PRESIDENT/DIRECTOR
Name : SAJAL K ROY
Credential :
Telephone Number : 850-622-3313
Provider Enumeration Date : 03/23/2011
Last Update Date : 01/14/2026

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Directions to “SOUTH WALTON PHARMACY LLC ” Practice Location

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