Provider Demographics
NPI:1457393993
Name:FCS PHARMACY LLC
Entity Type:Organization
Organization Name:FCS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-314-1700
Mailing Address - Street 1:PO BOX 533211
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28290-3211
Mailing Address - Country:US
Mailing Address - Phone:800-223-7151
Mailing Address - Fax:561-995-9162
Practice Address - Street 1:951 BROKEN SOUND PKWY
Practice Address - Street 2:SUITE 252
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3507
Practice Address - Country:US
Practice Address - Phone:800-223-7151
Practice Address - Fax:561-995-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18941333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025907100Medicaid
IN200410770AMedicaid
FL025907100Medicaid
IN200410770AMedicaid
P8313Medicare ID - Type Unspecified