SOUTHEASTERN INTEGRATED MEDICAL PA
Suppliers at Newberry Rd, Gainesville, FL

License number
Florida PH21312
Category
Suppliers
Type
Community/Retail Pharmacy
Owner
Name: MRS. LYNN W BENNETT RPH
Title: PHARMACY DIRECTOR
Phone: (352) 224-2450
Address
Address
4343 W Newberry Rd SUITE 9, Gainesville, FL 32607
National Provider ID: 1376616698
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SOUTHEASTERN INTEGRATED MEDICAL, PA

Gainesville, FL

Status:
Inactive
Inactive reason:
CORPORATE MERGER
Registration:
Jun 15, 1987
Inactive since:
Apr 17, 2006
Addresses:
4881 NW 8 Ave SUITE 2, Gainesville, FL 32605 (Physical)
Gainesville, FL 32635 (Mailing)
PO Box 357010, Gainesville, FL 32635
State ID:
J77571
Business type:
Florida Profit Corporation
Directors:
Oscar B Depaz Director, inactive, 4881 NW 8 Ave, Gainesville, FL 32605 (Physical),Oregon K Hunter Director, inactive, 4881 NW 8 Ave STE 2, Gainesville, FL 32605 (Physical),Rigoberto Puente-Guzman Director, inactive, 4881 NW 8 Ave #2, Gainesville, FL 32605 (Physical),...
Agent:
Krueger, Scott,2750 NW 43 St SUITE 201, Gainesville, FL 32606 (Physical)
EIN:
592819741

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