Provider Demographics
NPI:1053330043
Name:COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY INC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADETAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLAYINKA
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARMACY
Authorized Official - Phone:386-698-2666
Mailing Address - Street 1:897 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-2109
Mailing Address - Country:US
Mailing Address - Phone:386-698-2666
Mailing Address - Fax:386-698-1779
Practice Address - Street 1:897 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2109
Practice Address - Country:US
Practice Address - Phone:386-698-2666
Practice Address - Fax:386-698-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 214113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5534660001Medicare NSC