Organization
MARK CASEY PHILLIPS
Active
Other names
Extended Care Pharmacy Hastings
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PHILLIPS (PRESIDENT/PHCY OWNER)
(904) 692-4748
Entity
Organization
Contact information
Practice address
100 N MAIN ST, HASTINGS, FL 32145
(904) 692-4748
(904) 692-1085
Mailing address
PO BOX 640, HASTINGS, FL 32145-0640
(904) 692-4748
(904) 692-1085
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH24460
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002033800
—
FL
01
—
1050486
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/18/2009
Last updated
02/05/2013
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