Provider Demographics
NPI:1629343439
Name:PHARMCLINIC
Entity Type:Organization
Organization Name:PHARMCLINIC
Other - Org Name:WELLNESS AND WEIGHT LOSS OF FORT WALTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DENSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:850-683-1111
Mailing Address - Street 1:1116 N FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-1710
Mailing Address - Country:US
Mailing Address - Phone:850-683-1111
Mailing Address - Fax:850-683-1753
Practice Address - Street 1:1013 MAR WALT DR STE B
Practice Address - Street 2:
Practice Address - City:FT WALTON BCH
Practice Address - State:FL
Practice Address - Zip Code:32547-6789
Practice Address - Country:US
Practice Address - Phone:850-863-2222
Practice Address - Fax:850-863-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service