Provider Demographics
NPI:1023437134
Name:GOLDENROD PHARMACY
Entity type:Organization
Organization Name:GOLDENROD PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANUPAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:C
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-474-9393
Mailing Address - Street 1:1952 E OSCEOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8626
Mailing Address - Country:US
Mailing Address - Phone:321-214-0062
Mailing Address - Fax:
Practice Address - Street 1:1952 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8626
Practice Address - Country:US
Practice Address - Phone:321-214-0062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH276673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145168OtherPK