Organization
EXTENDED CARE PHARMACY EAST INC
Active
Organization
EXTENDED CARE PHARMACY EAST INC
Active
Other names
EXTENDED CARE PHARMACY EAST inc
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CASEY PHILLIPS (CPT/OWNER)
(386) 326-4487
Entity
Organization
Contact information
Practice address
305 S US HIGHWAY 17, EAST PALATKA, FL 32131-4092
(386) 326-4487
(386) 326-4437
Mailing address
305 S US HIGHWAY 17, EAST PALATKA, FL 32131-4092
(386) 326-4487
(386) 326-4437
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH26112
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5708118
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/10/2011
Last updated
08/07/2012
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