Provider Demographics
NPI:1265875090
Name:CENTRAL FL PHARMACY CORP
Entity type:Organization
Organization Name:CENTRAL FL PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUANLE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOAKUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:407-929-9662
Mailing Address - Street 1:1219 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4701
Mailing Address - Country:US
Mailing Address - Phone:407-898-0055
Mailing Address - Fax:407-898-0056
Practice Address - Street 1:1219 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4701
Practice Address - Country:US
Practice Address - Phone:407-898-0055
Practice Address - Fax:407-898-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336C0004X, 333600000X
FLPH267903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009919400Medicaid
2138269OtherPK