Provider Demographics
NPI:1255683835
Name:GREAT CARE PHARMACY INC
Entity Type:Organization
Organization Name:GREAT CARE PHARMACY INC
Other - Org Name:GREAT CARE PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-249-9235
Mailing Address - Street 1:2505 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2947
Mailing Address - Country:US
Mailing Address - Phone:305-636-2994
Mailing Address - Fax:305-636-2899
Practice Address - Street 1:2505 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-2947
Practice Address - Country:US
Practice Address - Phone:305-636-2994
Practice Address - Fax:305-636-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH306983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137283OtherPK
FL007189100Medicaid