Provider Demographics
NPI:1407392905
Name:UNIVERSITY OF FLORIDA MEDICATION MANAGEMENT CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF FLORIDA MEDICATION MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MTM PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:352-273-9045
Mailing Address - Street 1:2046 NE WALDO RD
Mailing Address - Street 2:SUITE 2250
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8975
Mailing Address - Country:US
Mailing Address - Phone:352-273-9045
Mailing Address - Fax:352-273-9658
Practice Address - Street 1:2046 NE WALDO RD
Practice Address - Street 2:SUITE 2250
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8975
Practice Address - Country:US
Practice Address - Phone:352-273-9045
Practice Address - Fax:352-273-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty