Organization
MACK BAYOU PHARMACY LLC
Active
Other names
Mack Bayou Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMY FRAZIER PHARMD (OWNER)
(850) 622-0730
Entity
Organization
Contact information
Practice address
82 MACK BAYOU LOOP STE B, SANTA ROSA BEACH, FL 32459-2607
(850) 622-0730
(850) 622-0755
Mailing address
82 MACK BAYOU LOOP STE B, SANTA ROSA BEACH, FL 32459-2607
(850) 622-0730
(850) 622-0755
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH26321
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137562
PK
—
Enumeration date
07/24/2012
Last updated
03/01/2017
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