Organization
SEMINOLE PHARMACY
Active
Other names
SEMINOLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA OBAN (PHARMACY PROGRAM MANAGER)
(954) 965-1331
Entity
Organization
Contact information
Practice address
31055 JOSIE BILLIE HIGHWAY, CLEWISTON, FL 33440
(863) 983-1197
(863) 983-1214
Mailing address
30290 JOSIE BILLIE HWY, CLEWISTON, FL 33440-9502
(863) 983-1197
(863) 983-1214
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169622
PK
—
Enumeration date
06/06/2017
Last updated
07/21/2022
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