Provider Demographics
NPI:1952484628
Name:CONCERNCARE PHARMACY
Entity Type:Organization
Organization Name:CONCERNCARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:VINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-995-7207
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:SUITE 52B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-858-0212
Mailing Address - Fax:
Practice Address - Street 1:148B W GREEN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3009
Practice Address - Country:US
Practice Address - Phone:601-894-6098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05390/02.2333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4513290001Medicare ID - Type UnspecifiedDME/PHARMACY