Provider Demographics
NPI:1356573182
Name:PARKWOOD PHARMACY, INC.
Entity type:Organization
Organization Name:PARKWOOD PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-849-2577
Mailing Address - Street 1:7920 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6713
Mailing Address - Country:US
Mailing Address - Phone:727-849-2577
Mailing Address - Fax:727-847-5024
Practice Address - Street 1:9706 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-3003
Practice Address - Country:US
Practice Address - Phone:727-863-2052
Practice Address - Fax:727-869-8441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKWOOD PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313570332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104451601Medicaid
FL104451601Medicaid