Organization
MAGNOLIA PHARMACY LLC
Active
Other names
Magnolia Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON CORKREAN (OWNER/PHARMACIST)
(352) 409-1061
Entity
Organization
Contact information
Practice address
12525 CURLEY ST, SAN ANTONIO, FL 33576-7094
(352) 588-3330
(352) 588-3337
Mailing address
12525 CURLEY ST, SAN ANTONIO, FL 33576-7094
(352) 588-3330
(352) 588-3337
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26768
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008645900
—
FL
01
—
2139695
PK
—
Enumeration date
03/25/2013
Last updated
07/13/2023
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