Organization
BUNNELL PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH CORGAN RPH (OWNER)
(386) 437-3325
Entity
Organization
Contact information
Practice address
706 E MOODY BLVD, BUNNELL, FL 32110-0895
(386) 437-3325
(386) 437-1533
Mailing address
PO BOX 895, BUNNELL, FL 32110-0895
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH0008958
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007790
OTHER ID NUMBER
—
Enumeration date
08/25/2006
Last updated
09/13/2007
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