Provider Demographics
NPI:1346550209
Name:MACCLENNY PHARMACY COMPANY
Entity Type:Organization
Organization Name:MACCLENNY PHARMACY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:EGBULAM
Authorized Official - Last Name:OPARA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-259-1116
Mailing Address - Street 1:5486 HIDDEN RIDGE DR
Mailing Address - Street 2:D-1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-3217
Mailing Address - Country:US
Mailing Address - Phone:904-259-1116
Mailing Address - Fax:904-259-1118
Practice Address - Street 1:1254 S 6TH ST
Practice Address - Street 2:D-1
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-4619
Practice Address - Country:US
Practice Address - Phone:904-259-1116
Practice Address - Fax:904-259-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy