Provider Demographics
NPI:1104837608
Name:WEEKS S PHARMACY LLC
Entity Type:Organization
Organization Name:WEEKS S PHARMACY LLC
Other - Org Name:WEEKS PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-835-2028
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-0432
Mailing Address - Country:US
Mailing Address - Phone:850-835-2028
Mailing Address - Fax:850-835-4923
Practice Address - Street 1:132 STATE HIGHWAY 20 E
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-3917
Practice Address - Country:US
Practice Address - Phone:850-835-2028
Practice Address - Fax:850-835-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH72313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005712OtherPK
FL104210600Medicaid