Provider Demographics
NPI:1275722308
Name:FLORIDA AGRICULTURE AND MECHANICAL UNIVERSITY
Entity Type:Organization
Organization Name:FLORIDA AGRICULTURE AND MECHANICAL UNIVERSITY
Other - Org Name:FAMU PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DEAN/PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:HONEYWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-599-3301
Mailing Address - Street 1:438 W BREVARD ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1004
Mailing Address - Country:US
Mailing Address - Phone:850-412-5490
Mailing Address - Fax:850-412-5491
Practice Address - Street 1:438 W BREVARD ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1004
Practice Address - Country:US
Practice Address - Phone:850-412-5490
Practice Address - Fax:850-412-5491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA AGRICULTURE AND MECHANICAL UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-15
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21824261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH21824OtherPHARMACY LICENSE