Provider Demographics
NPI:1013126978
Name:CONSOLIDATED PHARMACY SERVICES
Entity Type:Organization
Organization Name:CONSOLIDATED PHARMACY SERVICES
Other - Org Name:WALK OF HOPE BOUTIQE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM COO
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-308-1290
Mailing Address - Street 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4753
Mailing Address - Country:US
Mailing Address - Phone:904-308-7220
Mailing Address - Fax:904-308-7234
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-308-7220
Practice Address - Fax:904-308-7234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSOLIDATED PHARMACY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-21
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5698230001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5688910002Medicare NSC