Provider Demographics
NPI:1639178536
Name:PHARMACY INVESTMENT COORDINATORS, INC
Entity Type:Organization
Organization Name:PHARMACY INVESTMENT COORDINATORS, INC
Other - Org Name:MAITLAND REXALL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-435-7642
Mailing Address - Street 1:2009 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1576
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:
Practice Address - Street 1:145 S ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5692
Practice Address - Country:US
Practice Address - Phone:407-644-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10890333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP7515729OtherDEA NUMBER
FLBP7515729OtherDEA NUMBER