Provider Demographics
NPI:1972273639
Name:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSMOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:352-415-6612
Mailing Address - Street 1:1200 NE 55TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-2783
Mailing Address - Country:US
Mailing Address - Phone:352-415-6612
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 55TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-2783
Practice Address - Country:US
Practice Address - Phone:352-415-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital