Provider Demographics
NPI:1902859960
Name:MERCY COMMUNITY PHARMACY, LLC
Entity Type:Organization
Organization Name:MERCY COMMUNITY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:863-293-0300
Mailing Address - Street 1:362 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4002
Mailing Address - Country:US
Mailing Address - Phone:863-293-0300
Mailing Address - Fax:863-293-0388
Practice Address - Street 1:362 3RD ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4002
Practice Address - Country:US
Practice Address - Phone:863-293-0300
Practice Address - Fax:863-293-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty