Provider Demographics
NPI:1396884342
Name:SACRED HEART OUT PATIENT PHARMACY
Entity type:Organization
Organization Name:SACRED HEART OUT PATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-416-7137
Mailing Address - Street 1:5149 N 9TH AVE
Mailing Address - Street 2:STE 1137
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5149 N 9TH AVE
Practice Address - Street 2:STE 1137
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8756
Practice Address - Country:US
Practice Address - Phone:850-416-7137
Practice Address - Fax:850-416-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336M0002X, 333600000X, 332B00000X
FLPH00126903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1024239OtherOTHER ID NUMBER
1024239OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1024239OtherOTHER ID NUMBER