Provider Demographics
NPI:1780724773
Name:STUDENT HEALTH PHARMACY AT THE UNIVERSITY OF FLORIDA
Entity type:Organization
Organization Name:STUDENT HEALTH PHARMACY AT THE UNIVERSITY OF FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-392-1161
Mailing Address - Street 1:PO BOX 117500
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-7500
Mailing Address - Country:US
Mailing Address - Phone:352-392-1760
Mailing Address - Fax:352-846-1521
Practice Address - Street 1:280 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2038
Practice Address - Country:US
Practice Address - Phone:352-392-1760
Practice Address - Fax:352-846-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH81243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1010583OtherNCPDP PROVIDER IDENTIFICATION NUMBER