Organization
SERVICE DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY M COOK PHARMD (OWNER/PRESIDENT)
(850) 263-3257
Entity
Organization
Contact information
Practice address
5341 BROWN ST., GRACEVILLE, FL 32440
(850) 263-3257
(850) 263-3220
Mailing address
P.O. BOX 216, GRACEVILLE, FL 32440
(850) 263-3257
(850) 263-3220
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH25848
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100454900
—
FL
05
—
100454901
—
FL
01
—
1039153
NABP
FL
Enumeration date
08/06/2007
Last updated
11/15/2013
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