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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