Organization
CRESTVIEW PHARMACY, LLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up