Provider Demographics
NPI:1437245990
Name:CONSOLIDATED PHARMACY SERVICES, INC
Entity Type:Organization
Organization Name:CONSOLIDATED PHARMACY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM COO
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-308-1290
Mailing Address - Street 1:2651 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4519
Mailing Address - Country:US
Mailing Address - Phone:904-387-2448
Mailing Address - Fax:904-387-0153
Practice Address - Street 1:2651 PARK STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4519
Practice Address - Country:US
Practice Address - Phone:904-387-2448
Practice Address - Fax:904-387-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH-00094303336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022452900Medicaid
FLPH-0009430OtherSTATE LICENSE