Provider Demographics
NPI:1407320807
Name:ABACOA PHARMACY INC
Entity Type:Organization
Organization Name:ABACOA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:O CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-660-7585
Mailing Address - Street 1:500 UNIVERSITY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2774
Mailing Address - Country:US
Mailing Address - Phone:561-660-7585
Mailing Address - Fax:561-660-7594
Practice Address - Street 1:500 UNIVERSITY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2774
Practice Address - Country:US
Practice Address - Phone:561-660-7585
Practice Address - Fax:561-660-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH31846OtherFLORIDA PHARMACY LICENSE