# PARK SHORE DRUG INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Shore Pharmacon
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417043100
- **Authorized official:** MR. ROBERT D GILLIS R.PH. (PRESIDENT.)
- **Authorized official phone:** (954) 874-4646

## Contact information

- **Practice address:** 600 ANSIN BLVD, HALLANDALE BEACH, FL 33009-2118
- **Practice address phone:** (954) 874-4646
- **Practice address fax:** (954) 455-1378
- **Mailing address:** 600 ANSIN BLVD, HALLANDALE BEACH, FL 33009-2118
- **Mailing address phone:** (954) 874-4646
- **Mailing address fax:** (954) 455-1378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | PH13376 | FL | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 06/21/2012