Vintage Pharmacy

LBN: Vintage Pharmacy Llc
Vintage Pharmacy is an health care organization with primary practice located at 104 S Old Dixie Hwy , Lady Lake FL 32159-4349. The organization recently has 7 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy, Suppliers / Home Infusion Therapy Pharmacy, Suppliers / Long Term Care Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Vintage Pharmacy Llc can be contacted via phone (352) 751-6895, or through Harrison, Patti via phone (352) 751-6895.

Contact Information

Primary practice address
104 S Old Dixie Hwy Lady Lake FL 32159-4349
Phone: (352) 751-6895
Fax: (352) 751-6894
Website:
Map and Directions
Authorized official contact:
Name: Harrison, Patti CPHT/RPT
Phone: (352) 751-6895

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PH20910 Florida
Suppliers / Compounding Pharmacy 3336C0004X
Suppliers / Home Infusion Therapy Pharmacy 3336H0001X
Suppliers / Long Term Care Pharmacy 3336L0003X
Suppliers / Specialty Pharmacy 3336S0011X

Profile Details

NPI number 1386680908
LBN Legal business name Vintage Pharmacy Llc
DBA Doing business as Vintage Pharmacy
Authorized official Harrison, Patti CPHT/RPT
Entity Organization
Organization subpart 1 No
Enumeration date Jun 21st, 2006
Last updated Jan 9th, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386680908 NPPES
Other 2003982 PK
MEDICAID 028308800 PK

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