Organization
EASTPORT PHARMACY LLC
Active
Organization
EASTPORT PHARMACY LLC
Active
Other names
EASTPORT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HASSAN BAZZI RPH (OWNER, MGR, PIC)
(772) 324-1512
Entity
Organization
Contact information
Practice address
8972 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-3403
(772) 800-7267
(772) 800-7265
Mailing address
8972 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-3403
(772) 800-7267
(772) 800-7265
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH28441
FL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013952500
—
FL
01
—
2146100
PK
—
Enumeration date
08/22/2014
Last updated
02/26/2015
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