Provider Demographics
NPI:1700421286
Name:FLORALA PHARMACY INC
Entity Type:Organization
Organization Name:FLORALA PHARMACY INC
Other - Org Name:PHARMACARE GEORGIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:334-858-3291
Mailing Address - Street 1:23355 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-3818
Mailing Address - Country:US
Mailing Address - Phone:334-858-3291
Mailing Address - Fax:
Practice Address - Street 1:402 MEETING AVENUE
Practice Address - Street 2:
Practice Address - City:GEORGIANA
Practice Address - State:AL
Practice Address - Zip Code:36033
Practice Address - Country:US
Practice Address - Phone:334-376-2000
Practice Address - Fax:334-376-2276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORALA PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-08
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL241564Medicaid