Provider Demographics
NPI: | 1811236938 |
---|---|
Name: | CITRUS SPRINGS PHARMACY INC |
Entity Type: | Organization |
Organization Name: | CITRUS SPRINGS PHARMACY INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHARMACIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | OSARHIEME |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | IGBINOBA OKOJIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 770-329-8454 |
Mailing Address - Street 1: | 10479 N FLORIDA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CITRUS SPRINGS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34434-3268 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-489-1341 |
Mailing Address - Fax: | 352-489-1343 |
Practice Address - Street 1: | 10479 N FLORIDA AVE |
Practice Address - Street 2: | |
Practice Address - City: | CITRUS SPRINGS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34434-3268 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-489-1341 |
Practice Address - Fax: | 352-489-1343 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-02-08 |
Last Update Date: | 2013-02-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PH26705 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |