Organization · Type 2 NPI

Department of Children & Familes

Long Term Care Pharmacy · Macclenny, FL

NPI number 1629227442 Active

Practice location

7487 S State Road 121
Macclenny, FL 32063-5451

Fax (904) 259-6709

Specialties and licenses

Taxonomy	Code	License
Pharmacy	333600000X	None listed
Long Term Care Pharmacy Primary	3336L0003X	None listed

Long Term Care Pharmacy: A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

29 other providers at this address

NPI record

NPI: 1629227442
Entity type: Organization (Type 2)
Issued: Sep 17, 2008
Last updated: Jul 30, 2019
Status: Active

Other names

<unavail>
Northeast Florida State Hospital Pharmacy · doing business as
Northeast Florida State Hospital Pharmacy · doing business as

Authorized official

Dr. Tan H Pham, PharmD
Pharmacy Manager
(904) 330-2011

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1629227442

Department of Children & Familes's National Provider Identifier is 1629227442, issued on Sep 17, 2008. The primary taxonomy on file is Long Term Care Pharmacy (3336L0003X), and the practice location is in Macclenny, FL. The record was last updated on Jul 30, 2019.