Provider Demographics
NPI:1316958069
Name:NORTH FLORIDA PHARMACY OF BRANFORD INC
Entity type:Organization
Organization Name:NORTH FLORIDA PHARMACY OF BRANFORD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:386-935-6905
Mailing Address - Street 1:305 SW US HWY 27
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-2767
Mailing Address - Country:US
Mailing Address - Phone:386-935-6905
Mailing Address - Fax:386-935-6865
Practice Address - Street 1:305 SW US HWY 27
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-2767
Practice Address - Country:US
Practice Address - Phone:386-935-6905
Practice Address - Fax:386-935-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH156013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106249200Medicaid
1081506OtherOTHER ID NUMBER
FL106249201Medicaid
1186170001Medicare NSC