Provider Demographics
NPI:1144747700
Name:ST FLORIAN PHARMACY INC
Entity Type:Organization
Organization Name:ST FLORIAN PHARMACY INC
Other - Org Name:ST. FLORIAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRES, TCH, AO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-765-0123
Mailing Address - Street 1:4395 COUNTY ROAD 47
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-8998
Mailing Address - Country:US
Mailing Address - Phone:256-765-0123
Mailing Address - Fax:256-765-0124
Practice Address - Street 1:4395 COUNTY ROAD 47
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-8998
Practice Address - Country:US
Practice Address - Phone:256-765-0123
Practice Address - Fax:256-765-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
AL1147563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171240OtherPK