Organization
JACK P HERICK INC
Active
Other names
GLADES DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE MYERS RPH (PRESIDENT)
(561) 924-7701
Entity
Organization
Contact information
Practice address
109 S LAKE AVE, PAHOKEE, FL 33476-1803
(561) 924-7701
(561) 924-9933
Mailing address
109 S LAKE AVE, PAHOKEE, FL 33476-1803
(561) 924-7701
(561) 924-9933
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH1149
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015317200
—
FL
01
—
1018591
NCPDP
FL
Enumeration date
10/14/2005
Last updated
10/19/2015
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