1285700468 NPI number — UNIVERSITY OF CENTRAL FLORIDA PHARMACY

Table of content: (NPI 1285700468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285700468 NPI number — UNIVERSITY OF CENTRAL FLORIDA PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CENTRAL FLORIDA PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285700468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 CENTRAL FLORIDA BLVD
Provider Second Line Business Mailing Address:
HEALTH SERVICES BLDG. 127
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32816-3333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-823-6337
Provider Business Mailing Address Fax Number:
407-823-6756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 CENTRAL FLORIDA BLVD
Provider Second Line Business Practice Location Address:
HEALTH SERVICES BLDG. 127
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32816-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-823-6337
Provider Business Practice Location Address Fax Number:
407-823-6756
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAMBLE
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
407-823-6337

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH8211 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101351000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com