Provider Demographics
NPI:1669192761
Name:FLORENCE PHARMACY LLC
Entity type:Organization
Organization Name:FLORENCE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-729-5583
Mailing Address - Street 1:695 HONEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4568
Mailing Address - Country:US
Mailing Address - Phone:912-348-1811
Mailing Address - Fax:912-988-3097
Practice Address - Street 1:1017 US HIGHWAY 80 E STE 10
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9533
Practice Address - Country:US
Practice Address - Phone:912-348-1811
Practice Address - Fax:912-988-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy