SOUTHEASTERN DERMATOLOGY GROUP PA (NPI# 1871087882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871087882 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN DERMATOLOGY GROUP PA |
| Other Organization Name | SOUTHEASTERN PHARMACY |
| Practice Address |
2505 Harrison Ave Ste A Panama City FL 32405 |
| Mailing Address |
2505 Harrison Ave Panama City FL 32405-4423 |
| Practice Telephone | 8503877780 |
| Practice Fax Number | 8503877781 |
| Mailing Telephone | 8503877780 |
| Mailing Fax Number | 7733598571 |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-25 |
| Authorized Official Name | PAULA HADDOCK (DIRECTOR) |
| Authorized Official Telephone | 8502524422 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHEASTERN DERMATOLOGY GROUP, PA |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PH31415 | FL | Suppliers |
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
PH31415 | FL | Suppliers |
| Other Name | Type Code |
|---|---|
| Southeastern Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518972231 | Southeastern Dermatology Group Pa | Dermatology | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2006-07-30 |
| Street Address |
2505 HARRISON AVE STE A |
| City | PANAMA CITY |
| State | FL |
| Zip Code | 32405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457962136 | Kimberlea Fox | Behavioral Analyst | 4750 Collegiate Drive, Technology Building 157, Panama City, FL 32405 | 2020-08-14 |
| 1598325714 | Covenant Home Health Care, LLC | Home Health | 107 W. 19th Street, Panama City, FL 32405 | 2019-06-19 |
| 1467921403 | Amy Hancock | Counselor | 1212 W. 19th St., Panama City, FL 32405 | 2018-11-20 |
| 1063991917 | Patricia Kagendo Mutunga | Day Training, Developmentally Disabled Services | 2813 Fairmont Dr, Panama City, FL 32405 | 2018-08-11 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1437658424 | Coastal Mobility Transportation, LLC | Non-emergency Medical Transport (VAN) | 203 Forest Park Circle, Panama City, FL 32405 | 2018-02-06 |
| 1003314915 | The Anti-aging Clinic of Northwest Florida | Obstetrics & Gynecology | 3019 Osprey Cir, Panama City, FL 32405 | 2018-01-25 |
| 1255848487 | Sarah Theriot | Social Worker | 700 W 23rd St Bldg H, Panama City, FL 32405 | 2018-01-09 |
| 1336686054 | Angela Leake | Registered Nurse | 449 W 23 St, Panama City, FL 32405 | 2017-01-20 |
| 1144678855 | Faith Olivia Woerner | Behavioral Analyst | 4750 Collegiate Dr., Panama City, FL 32405 | 2016-06-03 |
| Find all providers in zip 32405 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790162311 | Callaway Gulf Coast Pharmacy | Pharmacy | 420 N Tyndall Pkwy, Panama City, FL 32404-6125 | 2015-05-04 |
| 1063824787 | Coastal Care Pharmacy LLC | Pharmacy | 11939 Panama City Beach Pkwy, Panama City, FL 32407-2605 | 2014-05-29 |
| 1578807350 | Wal-mart Stores East Lp | Pharmacy | 513 W 23rd St, Panama City, FL 32405-3920 | 2012-11-19 |
| 1780712612 | Panama City Pharmacy Inc | Pharmacy | 1108 Harrison Ave, Panama City, FL 32401-2431 | 2007-03-01 |
| 1326183898 | Manfy Inc | Pharmacy | 2303 W 15th St Ste D, Panama City, FL 32401-1500 | 2007-02-21 |
| 1083789986 | Walgreen Co. | Pharmacy | 301 N Tyndall Pkwy, Panama City, FL 32404-6124 | 2006-11-24 |
| 1275637142 | Holiday Cvs LLC | Pharmacy | 955 W 23rd St, Panama City, FL 32405-3928 | 2006-09-12 |
| 1811091788 | Holiday Cvs LLC | Pharmacy | 660 E Highway 98, Panama City, FL 32401-3612 | 2006-09-12 |
| 1467556316 | Holiday Cvs LLC | Pharmacy | 302 N Tyndall Pkwy, Panama City, FL 32404-6123 | 2006-09-12 |
| 1336704196 | Pancare of Florida, Inc | Pharmacy | 2309 E 15th St, Panama City, FL 32405-6345 | 2019-05-07 |
| Find all providers in PANAMA CITY | ||||
| City | PANAMA CITY |
| Zip Code | 32405 |
Please comment or provide details below to improve the information on SOUTHEASTERN DERMATOLOGY GROUP PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.