1699443895 NPI number — Z & G PHARMACY, LLC

Table of content: (NPI 1699443895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699443895 NPI number — Z & G PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Z & G PHARMACY, LLC
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:
ELITE CARE PHARMACY, A MEMBER OF THE MEDICINE SHOPPE FAMILY
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:
1699443895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4830 TIVERTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32934-7877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3680 N WICKHAM RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-608-4949
Provider Business Practice Location Address Fax Number:
321-477-5407
Provider Enumeration Date:
09/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VELEZ
Authorized Official First Name:
ZUHEILY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER & PIC
Authorized Official Telephone Number:
787-366-9141

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116176000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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