Provider Demographics
NPI:1457672057
Name:MD FAMILY PHARMACY
Entity Type:Organization
Organization Name:MD FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-343-0099
Mailing Address - Street 1:1100 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4201
Mailing Address - Country:US
Mailing Address - Phone:407-343-0099
Mailing Address - Fax:407-343-1283
Practice Address - Street 1:1100 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4201
Practice Address - Country:US
Practice Address - Phone:407-343-0099
Practice Address - Fax:407-343-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy