Organization
PARK AVENUE PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY PERRY CHASTAIN RPH (OWNER)
(850) 623-2222
Entity
Organization
Contact information
Practice address
5440 DOGWOOD DR, MILTON, FL 32570-3700
(850) 623-2222
(850) 981-9445
Mailing address
5440 DOGWOOD DR, MILTON, FL 32570-3700
(850) 623-2222
(850) 981-9445
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH20089
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006217
NABP
—
01
—
D8452
BCBS-FL
FL
Enumeration date
11/02/2006
Last updated
01/24/2008
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