Provider Demographics
NPI:1609111764
Name:CAB PHARMACY INC
Entity Type:Organization
Organization Name:CAB PHARMACY INC
Other - Org Name:GOOD HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BHARATH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-229-5974
Mailing Address - Street 1:1501 1ST ST S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4307
Mailing Address - Country:US
Mailing Address - Phone:863-229-5974
Mailing Address - Fax:863-229-5975
Practice Address - Street 1:1501 1ST ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4307
Practice Address - Country:US
Practice Address - Phone:863-229-5974
Practice Address - Fax:863-229-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH265273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008452300Medicaid
2138028OtherPK