Provider Demographics
NPI:1508296252
Name:GOOD HOMES PHARMACY, LLC
Entity Type:Organization
Organization Name:GOOD HOMES PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AAFAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-491-5582
Mailing Address - Street 1:8873 WEST COLONIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-6951
Mailing Address - Country:US
Mailing Address - Phone:407-253-2933
Mailing Address - Fax:407-253-2911
Practice Address - Street 1:8873 WEST COLONIAL DRIVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6951
Practice Address - Country:US
Practice Address - Phone:407-253-2933
Practice Address - Fax:407-253-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-16
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 271063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010392700Medicaid