Provider Demographics
NPI:1417251786
Name:FEDERAL DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:FEDERAL DISCOUNT PHARMACY INC
Other - Org Name:FEDERAL DISCOUNT PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEETING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-532-3943
Mailing Address - Street 1:229 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5322
Mailing Address - Country:US
Mailing Address - Phone:954-532-3943
Mailing Address - Fax:954-532-3952
Practice Address - Street 1:229 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5322
Practice Address - Country:US
Practice Address - Phone:954-532-3943
Practice Address - Fax:954-532-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH258773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708308OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL004435200Medicaid