Provider Demographics
NPI:1245399732
Name:CENTURY PHARMACY, LLC
Entity Type:Organization
Organization Name:CENTURY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOOTH-MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-256-3472
Mailing Address - Street 1:7531 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535-2906
Mailing Address - Country:US
Mailing Address - Phone:850-256-3472
Mailing Address - Fax:850-256-3529
Practice Address - Street 1:7531 MAYO ST
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535-2906
Practice Address - Country:US
Practice Address - Phone:850-256-3472
Practice Address - Fax:850-256-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18261332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4169560001Medicare ID - Type UnspecifiedMEDICARE