Organization
CRESTVIEW PHARMACY, LLC
Active
Other names
Crestview Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCE DAGRAVA PHARMD (COO)
(859) 552-5013
Entity
Organization
Contact information
Practice address
1116 N FERDON BLVD, CRESTVIEW, FL 32536-1710
(850) 683-1111
(850) 683-1753
Mailing address
1116 N FERDON BLVD, CRESTVIEW, FL 32536-1710
(850) 683-1111
(850) 683-1753
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH18397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025327800
—
FL
05
—
100200027
—
AL
01
—
1094870
NCPDP - NAPB
FL
Enumeration date
08/29/2006
Last updated
06/11/2019
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