Moultrie Pharmacy
LBN: Moultrie Pharmacy Inc
Moultrie Pharmacy is an health care organization with primary practice located at 3690 Us Highway 1 S , St Augustine FL 32086-6498. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Moultrie Pharmacy Inc can be contacted via phone (904) 794-1399, or through Mccarty, Delaine via phone (904) 794-1399.
Contact Information
Primary practice address
3690 Us Highway 1 S
St Augustine FL 32086-6498
Phone: (904) 794-1399
Fax: (904) 794-1193
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | PH19146 | Florida |
| Suppliers / Compounding Pharmacy | 3336C0004X |
Profile Details
| NPI number | 1740270099 |
|---|---|
| LBN Legal business name | Moultrie Pharmacy Inc |
| DBA Doing business as | Moultrie Pharmacy |
| Authorized official | Mccarty, Delaine |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Mar 29th, 2017 - about 7 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740270099 | NPPES |
| Florida | MEDICAID | 025956000 | |
| Florida | MEDICAID | 025956001 | |
| Florida | Other | 2015438 | |
| Florida | MEDICAID | 686878996 |
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