Provider Demographics
NPI:1497891006
Name:PIERSON COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:PIERSON COMMUNITY PHARMACY INC
Other - Org Name:PIERSON COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-749-9557
Mailing Address - Street 1:112 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32180-3039
Mailing Address - Country:US
Mailing Address - Phone:386-749-9557
Mailing Address - Fax:386-749-9512
Practice Address - Street 1:112 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:PIERSON
Practice Address - State:FL
Practice Address - Zip Code:32180-3039
Practice Address - Country:US
Practice Address - Phone:386-749-9557
Practice Address - Fax:386-749-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH210273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004564OtherPK
1258110004Medicare NSC