Provider Demographics
NPI:1265648885
Name:SEMINOLE COUNTY HEALTH DEPARTMENT PHARMACY
Entity Type:Organization
Organization Name:SEMINOLE COUNTY HEALTH DEPARTMENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-665-3324
Mailing Address - Street 1:400 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5489
Mailing Address - Country:US
Mailing Address - Phone:407-665-3324
Mailing Address - Fax:
Practice Address - Street 1:400 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5489
Practice Address - Country:US
Practice Address - Phone:407-665-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH87663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027969207Medicaid