Organization
DURA-MED SOUTHEAST INC
Active
Organization
DURA-MED SOUTHEAST INC
Active
Other names
Dura-Med Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY BLACKMON (SUPERVISING PHARMACIST)
(850) 365-0685
Entity
Organization
Contact information
Practice address
3877 HIGHWAY 4, JAY, FL 32565-1754
(850) 675-2448
Mailing address
PO BOX 640, JAY, FL 32565-0640
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
25155
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5703132
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/13/2010
Last updated
02/08/2011
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