Organization
A.G. HOLLEY STATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JERRY JEAN STAMBAUGH RPH (PHARMACIST)
(561) 540-3721
Entity
Organization
Contact information
Practice address
1199 LANTANA RD, LANTANA, FL 33462-1514
(561) 540-3721
(561) 545-0372
Mailing address
1199 LANTANA RD, LANTANA, FL 33462-1514
(561) 540-3721
(561) 545-0372
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PH0016562
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0215171-00
—
FL
Enumeration date
10/27/2006
Last updated
06/13/2008
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