Grandmas Country Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH0016731 Issued in FL

Legal business name

GRANDMAS COUNTRY PHARMACY INC

Doing business as

GRANDMAS COUNTRY PHARMACY INC

Practice address

11386 E Highway 316
Fort MC Coy, FL 32134-8114

Phone

(352) 236-0407

Fax

(352) 236-6343

NPI assigned

Nov 25, 2005

Organization subpart

No

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

Authorized official

Name

Marianne Glorius

Title

President

Phone

(362) 236-0407

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GRANDMAS COUNTRY PHARMACY INC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shari Defigueras, CPHT

  • Pharmacy Technician
  • Fort MC Coy, FL
  • NPI 1184045197
  NPD (past)

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1689657454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11386 E HIGHWAY 316",
            "city": "FORT MC COY",
            "state": "FL",
            "postal_code": "321348114",
            "telephone_number": "352-236-0407",
            "fax_number": "352-236-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11386 E HIGHWAY 316",
            "city": "FORT MC COY",
            "state": "FL",
            "postal_code": "321348114",
            "telephone_number": "352-236-0407",
            "fax_number": "352-236-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDMAS COUNTRY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-25",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "GLORIUS",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "362-236-0407"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH0016731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021480900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012542",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRANDMAS COUNTRY PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan S Anton, LMT
• Norma G Benitez, CPHT, RPHT, CCMA
• Breen Health, LLC
• Shari Defigueras, CPHT
• Marianne Elizabeth Glorius, R.PH.,FACVP
• Heavenly Hands Companion LLC
• Dawn Marie Jaquish, FNP-C
• Michelle Keim
• Sally Khan, PT
• Wendy Kingsley, APRN

• Community/Retail Pharmacy in Fort MC Coy, FL
• Providers in Fort MC Coy, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.