Provider Demographics
NPI:1437149218
Name:CYSTIC FIBROSIS PHARMACY, INC.
Entity Type:Organization
Organization Name:CYSTIC FIBROSIS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:N
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH, MBA
Authorized Official - Phone:407-898-4427
Mailing Address - Street 1:3901 E COLONIAL DR
Mailing Address - Street 2:SUITE 'D'
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5245
Mailing Address - Country:US
Mailing Address - Phone:407-898-4427
Mailing Address - Fax:407-897-2108
Practice Address - Street 1:3901 E COLONIAL DR
Practice Address - Street 2:SUITE 'D'
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5245
Practice Address - Country:US
Practice Address - Phone:407-898-4427
Practice Address - Fax:407-897-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH12570332B00000X, 332BP3500X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102656900Medicaid
FL102656900Medicaid