Provider Demographics
NPI:1598814287
Name:PARAMORES PHARMACY INC
Entity Type:Organization
Organization Name:PARAMORES PHARMACY INC
Other - Org Name:PARAMORES PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-482-3924
Mailing Address - Street 1:4314 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2182
Mailing Address - Country:US
Mailing Address - Phone:850-482-3924
Mailing Address - Fax:850-482-3886
Practice Address - Street 1:4314 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2182
Practice Address - Country:US
Practice Address - Phone:850-482-3924
Practice Address - Fax:850-482-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH87833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022833200Medicaid
2005233OtherPK