Provider Demographics
NPI:1821013715
Name:HOME CARE PHARMACY OF PALM COAST INC.
Entity Type:Organization
Organization Name:HOME CARE PHARMACY OF PALM COAST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:386-445-1212
Mailing Address - Street 1:6 FLORIDA PARK DR N
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3890
Mailing Address - Country:US
Mailing Address - Phone:386-445-1212
Mailing Address - Fax:386-446-5851
Practice Address - Street 1:6 FLORIDA PARK DR N
Practice Address - Street 2:SUITE A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3890
Practice Address - Country:US
Practice Address - Phone:386-445-1212
Practice Address - Fax:386-446-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH100633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109782201Medicaid
0381200001Medicare ID - Type Unspecified