Provider Demographics
NPI:1467964494
Name:FLORIDA HEALTH CARE PLAN, INC
Entity Type:Organization
Organization Name:FLORIDA HEALTH CARE PLAN, INC
Other - Org Name:FLORIDA HEALTH CARE PLANS PHARMACY-ST. AUGUSTINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-676-7100
Mailing Address - Street 1:2450 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5110
Mailing Address - Country:US
Mailing Address - Phone:386-615-5008
Mailing Address - Fax:386-676-7165
Practice Address - Street 1:200 SOUTHPARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3129
Practice Address - Country:US
Practice Address - Phone:904-295-3677
Practice Address - Fax:904-295-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH310023336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH31002OtherSTATE LICENSE