Provider Demographics
NPI:1104827724
Name:PRIORITY HEALTHCARE PHARMACY INC.
Entity Type:Organization
Organization Name:PRIORITY HEALTHCARE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-854-6532
Mailing Address - Street 1:6272 LEE VISTA BLVD
Mailing Address - Street 2:LEGAL DEPT
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5148
Mailing Address - Country:US
Mailing Address - Phone:888-773-7376
Mailing Address - Fax:888-773-7386
Practice Address - Street 1:250 TECHNOLOGY PARK
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7115
Practice Address - Country:US
Practice Address - Phone:800-892-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16300333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1070666Medicaid
MD91230100Medicaid
AKPH905FLMedicaid
CT3116440Medicaid
IA533851Medicaid
LA1269859Medicaid
FL22106600Medicaid
AZ498007Medicaid
KY54000435Medicaid
CO84326581Medicaid
MT212041Medicaid
ME=========Medicaid
MO=========-00Medicaid
MI1070666Medicaid
AKPH905FLMedicaid