Provider Demographics
NPI:1689719213
Name:GREAT CARE PHARMACY INC
Entity Type:Organization
Organization Name:GREAT CARE PHARMACY INC
Other - Org Name:GREAT CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-430-7970
Mailing Address - Street 1:17560 NW 27 AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17560 NW 27 AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056
Practice Address - Country:US
Practice Address - Phone:305-430-7970
Practice Address - Fax:305-430-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH199253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1004100OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL026687600Medicaid
5431360001Medicare NSC