Provider Demographics
NPI:1376546929
Name:MEDICATION STATION, INC,
Entity Type:Organization
Organization Name:MEDICATION STATION, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOODMANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-736-1010
Mailing Address - Street 1:141 EAST WOOLBRIGHT ROAD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-736-1010
Mailing Address - Fax:561-736-1272
Practice Address - Street 1:141 E WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6007
Practice Address - Country:US
Practice Address - Phone:561-736-1010
Practice Address - Fax:561-736-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0007708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104706000Medicaid
FL0127620001Medicare NSC