Provider Demographics
NPI:1568575520
Name:WEBB'S FORT MYERS PRESCRIPTION SHOP, INC.
Entity Type:Organization
Organization Name:WEBB'S FORT MYERS PRESCRIPTION SHOP, INC.
Other - Org Name:FORT MYERS PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:239-939-0249
Mailing Address - Street 1:13195 METRO PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4810
Mailing Address - Country:US
Mailing Address - Phone:239-939-0249
Mailing Address - Fax:239-936-2427
Practice Address - Street 1:13195 METRO PKWY STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4810
Practice Address - Country:US
Practice Address - Phone:239-939-0249
Practice Address - Fax:239-936-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1004908OtherNABP
FL101591500Medicaid