Provider Demographics
NPI:1649513482
Name:ORANGE PARK PHARMACY INC.
Entity type:Organization
Organization Name:ORANGE PARK PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHO
Authorized Official - Middle Name:
Authorized Official - Last Name:NKENGKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-579-3027
Mailing Address - Street 1:1992 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4442
Mailing Address - Country:US
Mailing Address - Phone:904-579-3027
Mailing Address - Fax:904-579-4551
Practice Address - Street 1:1992 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4442
Practice Address - Country:US
Practice Address - Phone:904-579-3027
Practice Address - Fax:904-579-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH265783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHM356AMedicare PIN