Provider Demographics
NPI:1518051093
Name:HRS CITRUS COUNTY HEALTH DEPT. PHARMACY
Entity Type:Organization
Organization Name:HRS CITRUS COUNTY HEALTH DEPT. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY HEALTH DEPARTMENT ADMINISTRA
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, PHD
Authorized Official - Phone:352-527-0068
Mailing Address - Street 1:2804 MARC KNIGHTON CT
Mailing Address - Street 2:BIN 14
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461
Mailing Address - Country:US
Mailing Address - Phone:352-249-9258
Mailing Address - Fax:352-527-3013
Practice Address - Street 1:2804 MARC KNIGHTON CT
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-527-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 13705332000000X
FLPH246813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103381600Medicaid
FLPH 13705OtherCOMMUNITY PHARMACY LICENS
FF2037504OtherDEA
FLPH 13705OtherCOMMUNITY PHARMACY LICENS