1487800264 NPI number — PINELLAS COMPOUNDING PHARMACY INC

Table of content: (NPI 1487800264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487800264 NPI number — PINELLAS COMPOUNDING PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINELLAS COMPOUNDING PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PINELLAS COMPOUNDING PHARMACY INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487800264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNEDIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34698-4759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-239-0300
Provider Business Mailing Address Fax Number:
888-888-8736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609-1611 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNEDIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-239-0300
Provider Business Practice Location Address Fax Number:
888-888-8736
Provider Enumeration Date:
08/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAH
Authorized Official First Name:
HOI-LING
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-239-0300

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: PH21242 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2004360 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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