Organization
DEPARTMENT OF CHILDREN & FAMILES
Active
Other names
Northeast Florida State Hospital Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAN H PHAM PHARM.D. (PHARMACY MANAGER)
(904) 330-2011
Entity
Organization
Contact information
Practice address
7487 S STATE ROAD 121, MACCLENNY, FL 32063-5451
(904) 259-6211
(904) 259-6709
Mailing address
7487 S STATE ROAD 121, MACCLENNY, FL 32063-5451
(904) 259-6211
(904) 259-6709
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026002900
—
FL
Enumeration date
09/17/2008
Last updated
07/30/2019
Update your record
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