Organization
JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC
Active
Other names
Oak Park LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VIBHA CHOUDHARY (PHARMACY DIRECTOR)
(386) 456-1500
Entity
Organization
Contact information
Practice address
701 MONASTERY RD STE B, ORANGE CITY, FL 32763-6222
(386) 456-1500
Mailing address
701 MONASTERY RD, SUITE B, ORANGE CITY, FL 32763-6222
(386) 456-1500
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PH28804
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149648
PK
—
Enumeration date
01/22/2015
Last updated
02/23/2015
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