Provider Demographics
NPI:1659572915
Name:COVENANT HOSPICE, INC.
Entity Type:Organization
Organization Name:COVENANT HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH
Authorized Official - Phone:850-433-2155
Mailing Address - Street 1:10075 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5469
Mailing Address - Country:US
Mailing Address - Phone:850-484-3529
Mailing Address - Fax:850-202-0600
Practice Address - Street 1:10075 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5469
Practice Address - Country:US
Practice Address - Phone:850-484-3529
Practice Address - Fax:850-202-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy