Provider Demographics
NPI:1437595907
Name:FAMILY PHARMACY AND MEDICAL LLC
Entity Type:Organization
Organization Name:FAMILY PHARMACY AND MEDICAL LLC
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:REQUENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-775-6800
Mailing Address - Street 1:5480 RATTLESNAKE HAMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7454
Mailing Address - Country:US
Mailing Address - Phone:239-775-6800
Mailing Address - Fax:239-775-7377
Practice Address - Street 1:5480 RATTLESNAKE HAMMOCK RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7454
Practice Address - Country:US
Practice Address - Phone:239-775-6800
Practice Address - Fax:239-775-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy