Ocoee Pharmacy, Inc
Organization Active NPI Community/Retail Pharmacy · Ocoee, TN
NPI 1740673235 · NPPES record last updated Oct 23, 2015
Key facts
- NPI
- 1740673235
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5645 (TN)
- Legal business name
- OCOEE PHARMACY, INC
- Practice address
- 186 Creekside Dr
Ocoee, TN 37361 - Phone
- (423) 299-9029
- NPI assigned
- Mar 9, 2015
- Organization subpart
- No
Authorized official
- Name
- Samuel Randolph, PHARMD
- Title
- Vice President/Pharmacist in Charge
- Phone
- (423) 506-6243
Practitioners 2
-
Samuel Randolph, PHARM.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161024001802 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 5395023568 | Practice locations: Ocoee, TN |
National Provider Directory
Locations
186 Creekside Dr
Ocoee, TN 37361
Phone (423) 299-9029
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 5645 | TN | Yes |
Addresses
Primary practice location
186 Creekside Dr
Ocoee, TN 37361
Mailing address
PO Box 297
Ocoee, TN 37361-0297
Phone (423) 299-9029
Other names
- FIRST CARE PHARMACY
Other providers in Ocoee, TN
- Rachel Harwood
- Thad Huff
- K-Vat Food Stores, Inc
- Victoria Knight
- Karen Milen
- Kimberly Peak
- Preferred Oxygen LLC
- Samuel Randolph
- Jeremy Swallows
- Dora D. Trivette
All providers in Ocoee, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.