Organization
OLD TOWN PHARMACY INC
Active
Other names
Old Town Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY HODGKINSON (BOOKKEEPER)
(386) 758-6770
Entity
Organization
Contact information
Practice address
26064 SE HWY 19, OLD TOWN, FL 32680
(352) 542-9301
(352) 542-9865
Mailing address
26064 SE HWY 19, OLD TOWN, FL 32680-3087
(352) 542-9301
(352) 542-9562
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144428
PK
—
Enumeration date
05/23/2014
Last updated
09/22/2020
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