1841244316 NPI number — GARRETT'S PHARMACY SERVICES, INC.

Table of content: (NPI 1841244316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841244316 NPI number — GARRETT'S PHARMACY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARRETT'S PHARMACY SERVICES, 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:
6
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:
1841244316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
536 E 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32536-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-628-2008
Provider Business Mailing Address Fax Number:
850-682-4145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
536 E 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32536-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-628-2008
Provider Business Practice Location Address Fax Number:
850-682-4145
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARRETT
Authorized Official First Name:
CLIFTON
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER-PHARMACIST
Authorized Official Telephone Number:
850-682-2008

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH 8508 , 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: 1048873 . This is a "NCPDP PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P4018 . This is a "FL. BLUE CROSS I.D." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 105219502 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105219500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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