Organization
SEASIDE FAMILY PHARMACY LLC
Active
Other names
SEASIDE FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES PENNINGTON RPH (CO OWNER)
(904) 461-3299
Entity
Organization
Contact information
Practice address
4075 A1A S, STE 102, ST AUGUSTINE, FL 32080-6773
(904) 461-3299
(904) 461-3277
Mailing address
4075 A1A S, STE 102, ST AUGUSTINE, FL 32080-6773
(904) 461-3299
(904) 461-3277
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH21889
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031351200
—
FL
01
—
1018301
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/18/2006
Last updated
02/06/2012
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