Organization
ORANGE PARK PHARMACY INC
Active
Other names
Orange Park Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
ABDALLA MOHAMED PHARMD (PHARMACY MANAGER/OWNER)
(904) 579-3027
Entity
Organization
Contact information
Practice address
1992 KINGSLEY AVE, SUITE B, ORANGE PARK, FL 32073-4442
(904) 579-3027
(904) 579-4551
Mailing address
1992 KINGSLEY AVE, SUITE B, ORANGE PARK, FL 32073-4442
(904) 579-3027
(904) 579-4551
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH30423
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023871800
—
FL
01
—
2166209
PK
—
Enumeration date
11/02/2016
Last updated
07/19/2018
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