1154426070 NPI number — SANTA ROSA PHARMACY, INC.

Table of content: (NPI 1154426070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154426070 NPI number — SANTA ROSA PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTA ROSA PHARMACY, INC.
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:
1154426070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 TOWN CENTER LOOP
Provider Second Line Business Mailing Address:
UNIT 1A
Provider Business Mailing Address City Name:
SANTA ROSA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-622-3313
Provider Business Mailing Address Fax Number:
850-622-3255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 TOWN CENTER LOOP
Provider Second Line Business Practice Location Address:
UNIT 1A
Provider Business Practice Location Address City Name:
SANTA ROSA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-622-3313
Provider Business Practice Location Address Fax Number:
850-622-3255
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLOWERS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRES.
Authorized Official Telephone Number:
850-622-3313

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH19512 , 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: 1001180 . This is a "NCPDP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com