Provider Demographics
NPI:1922300565
Name:JOSEPHS PHARMACY LLC
Entity Type:Organization
Organization Name:JOSEPHS PHARMACY LLC
Other - Org Name:JOSEPH'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAISON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-316-7604
Mailing Address - Street 1:7125 ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-8054
Mailing Address - Country:US
Mailing Address - Phone:850-332-6998
Mailing Address - Fax:
Practice Address - Street 1:3130 N PACE BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-5140
Practice Address - Country:US
Practice Address - Phone:850-332-6998
Practice Address - Fax:850-466-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH250803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5702902OtherNCPDP PROVIDER IDENTIFICATION NUMBER