Provider Demographics
NPI:1871325241
Name:UMATILLA PHARMACY INC
Entity type:Organization
Organization Name:UMATILLA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORKREAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:352-409-1061
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-1250
Mailing Address - Country:US
Mailing Address - Phone:352-409-1061
Mailing Address - Fax:
Practice Address - Street 1:901 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8655
Practice Address - Country:US
Practice Address - Phone:352-669-1166
Practice Address - Fax:352-669-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy