Provider Demographics
NPI:1659408516
Name:HALLIDAY'S DRUGS, INC.
Entity Type:Organization
Organization Name:HALLIDAY'S DRUGS, INC.
Other - Org Name:HALLIDAY'S & KOIVISTO'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-737-2216
Mailing Address - Street 1:4133 UNIVERSITY BLVD S # 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4316
Mailing Address - Country:US
Mailing Address - Phone:904-737-2216
Mailing Address - Fax:904-737-2218
Practice Address - Street 1:4133 UNIVERSITY BLVD S # 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4316
Practice Address - Country:US
Practice Address - Phone:904-737-2216
Practice Address - Fax:904-737-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100772601Medicaid
0377820001Medicare NSC