Provider Demographics
NPI:1548275159
Name:FT MEADE COMMUNITY PHARMACY INC
Entity type:Organization
Organization Name:FT MEADE COMMUNITY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:863-285-9285
Mailing Address - Street 1:107 W BROADWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-3300
Mailing Address - Country:US
Mailing Address - Phone:863-285-9285
Mailing Address - Fax:863-285-9982
Practice Address - Street 1:107 W BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:FL
Practice Address - Zip Code:33841-3300
Practice Address - Country:US
Practice Address - Phone:863-285-9285
Practice Address - Fax:863-285-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH217883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1017525OtherNCPDP PROVIDER IDENTIFICATION NUMBER