Provider Demographics
NPI:1720055775
Name:ENSLEY PHARMACY INC
Entity Type:Organization
Organization Name:ENSLEY PHARMACY INC
Other - Org Name:ENSLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:850-473-0428
Mailing Address - Street 1:5740 WESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-2333
Mailing Address - Country:US
Mailing Address - Phone:850-982-9087
Mailing Address - Fax:
Practice Address - Street 1:8814 N PALAFOX ST # C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-3029
Practice Address - Country:US
Practice Address - Phone:850-473-0428
Practice Address - Fax:850-473-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH166423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145514OtherPK
2145514OtherPK