Organization
MEDCITY PHARMACY
Active
Organization
MEDCITY PHARMACY
Active
Other names
MEDCITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUMANTH EDARA (CO-OWNER)
(904) 252-1568
Entity
Organization
Contact information
Practice address
463688 SR 200, SUITE #6, YULEE, FL 32097
(904) 432-3810
(904) 432-3811
Mailing address
11988 MARLDON LN, JACKSONVILLE, FL 32258-9459
(904) 252-1568
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26731
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5713816
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/25/2013
Last updated
03/25/2013
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