Provider Demographics
NPI:1841244316
Name:GARRETT'S PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:GARRETT'S PHARMACY SERVICES, INC.
Other - Org Name:THE PRESCRIPTION SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-682-2008
Mailing Address - Street 1:536 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2505
Mailing Address - Country:US
Mailing Address - Phone:850-628-2008
Mailing Address - Fax:850-682-4145
Practice Address - Street 1:536 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2505
Practice Address - Country:US
Practice Address - Phone:850-628-2008
Practice Address - Fax:850-682-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 85083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1048873OtherNCPDP PROVIDER NUMBER
FLP4018OtherFL. BLUE CROSS I.D.
FL105219502Medicaid
FL105219500Medicaid
FL1256010001Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL105219502Medicaid