Provider Demographics
NPI:1679138432
Name:PANCARE OF FLORIDA, INC
Entity Type:Organization
Organization Name:PANCARE OF FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-818-0455
Mailing Address - Street 1:5336 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-3429
Mailing Address - Country:US
Mailing Address - Phone:850-569-2021
Mailing Address - Fax:850-569-2022
Practice Address - Street 1:5336 10TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3429
Practice Address - Country:US
Practice Address - Phone:850-569-2021
Practice Address - Fax:850-569-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32055OtherBOARD OF PHARMACY