DAYTONA BEACH VA CLIN PHARMACY (4126)    INSTITUTION (4)

Name Value
NAME DAYTONA BEACH VA CLIN PHARMACY
STATE FLORIDA
STREET ADDR. 1 1776 N WILLIAMSON BLVD
CITY DAYTONA BEACH
ZIP 32117-5250
OFFICIAL VA NAME DAYTONA BEACH VA CLINIC PHARMACY
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME DAYTONA BEACH VA CLINIC PHARMACY
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1083947048
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
HISTORY
  • STREET ADDR. 1 (CHANGED FROM):   551 NATIONAL HEALTHCARE DR
    CITY (CHANGED FROM):   DAYTONA BEACH
    STATE (CHANGED FROM):   FLORIDA
    ZIP (CHANGED FROM):   32114-1495