Provider Demographics
NPI:1023090362
Name:SENIOR CARE PHARMACY OF FLORIDA LLC
Entity type:Organization
Organization Name:SENIOR CARE PHARMACY OF FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-577-1440
Mailing Address - Street 1:931 FAIRFAX PARK
Mailing Address - Street 2:ATTN: LYNN CONNOR
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2805
Mailing Address - Country:US
Mailing Address - Phone:205-310-8627
Mailing Address - Fax:
Practice Address - Street 1:4175 S PIPKIN RD STE 208
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1699
Practice Address - Country:US
Practice Address - Phone:863-577-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH187233336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2014992OtherPK
FL025634000Medicaid