Provider Demographics
NPI:1366441842
Name:PHARMACY INVESTMENT COORDINATORS INC
Entity type:Organization
Organization Name:PHARMACY INVESTMENT COORDINATORS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4571
Mailing Address - Street 1:PO BOX 72148
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2148
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-435-4734
Practice Address - Street 1:302 CECIL G COSTIN SR BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1905
Practice Address - Country:US
Practice Address - Phone:850-227-7099
Practice Address - Fax:850-227-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH198053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026658200Medicaid
2007299OtherPK
4500820004Medicare NSC