Provider Demographics
NPI:1669667424
Name:EVERWELL SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:EVERWELL SPECIALTY PHARMACY, LLC
Other - Org Name:PENSACOLA APOTHECARY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-712-7659
Mailing Address - Street 1:6506 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6957
Mailing Address - Country:US
Mailing Address - Phone:850-473-9190
Mailing Address - Fax:850-473-9935
Practice Address - Street 1:6506 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6957
Practice Address - Country:US
Practice Address - Phone:850-473-9190
Practice Address - Fax:850-473-9935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REVELATION PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-13
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH197483336C0003X
3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007134OtherPK
FL008486400Medicaid