NPIMap

Organization Active NPI

Department of Children & Familes

Doing business as Northeast Florida State Hospital Pharmacy

  • Long Term Care Pharmacy
  • Macclenny, FL
National Provider Identifier
1629227442
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
DEPARTMENT OF CHILDREN & FAMILES
Doing business as
Northeast Florida State Hospital Pharmacy
Practice address
7487 S State Road 121
Macclenny, FL 32063-5451
Phone
(904) 259-6211
Fax
(904) 259-6709
NPI assigned
Sep 17, 2008
Last updated
Jul 30, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tan H Pham, PHARM.D.
Title
Pharmacy Manager
Phone
(904) 330-2011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

7487 S State Road 121
Macclenny, FL 32063-5451

Mailing address

7487 S State Road 121
Macclenny, FL 32063-5451
Phone (904) 259-6211

Other identifiers 1

IdentifierTypeStateIssuer
026002900MedicaidFL

Other names 1

  • Northeast Florida State Hospital Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
FL Department of Childr9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1629227442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7487 S STATE ROAD 121",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320635451",
            "telephone_number": "904-259-6211",
            "fax_number": "904-259-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7487 S STATE ROAD 121",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320635451",
            "telephone_number": "904-259-6211",
            "fax_number": "904-259-6709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF CHILDREN & FAMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-17",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "TAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "904-330-2011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026002900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Florida State Hospital Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northeast Florida State Hospital Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macclenny, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.