Provider Demographics
NPI:1487674271
Name:NORTH FLORIDA PHARMACY OF MAYO, INC
Entity Type:Organization
Organization Name:NORTH FLORIDA PHARMACY OF MAYO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:386-294-3777
Mailing Address - Street 1:229 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 1510
Mailing Address - City:MAYO
Mailing Address - State:FL
Mailing Address - Zip Code:32066
Mailing Address - Country:US
Mailing Address - Phone:386-294-3777
Mailing Address - Fax:
Practice Address - Street 1:229 WEST MAIN STREET/ BOX 1510
Practice Address - Street 2:
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066
Practice Address - Country:US
Practice Address - Phone:386-294-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026343500Medicaid
FL026343501Medicaid
FLP8389OtherBLUE CROSS/BLUE SHIELD
FL026343500Medicaid