Provider Demographics
NPI:1194734038
Name:NORTH FLORIDA PHARMACY, INC.
Entity type:Organization
Organization Name:NORTH FLORIDA PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-758-9300
Mailing Address - Street 1:3718 W US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4897
Mailing Address - Country:US
Mailing Address - Phone:386-755-9300
Mailing Address - Fax:386-755-9371
Practice Address - Street 1:3718 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4897
Practice Address - Country:US
Practice Address - Phone:386-755-9300
Practice Address - Fax:386-755-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15487332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1081025OtherOTHER ID NUMBER
FL106155101OtherMEDICAID DME
FL106155100Medicaid
FL106155101OtherMEDICAID DME