Organization
COUNTRYSIDE PHARMACY
Active
Organization
COUNTRYSIDE PHARMACY
Active
Other names
Shields Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ADEL YOUSSEF (MANAGER)
(727) 648-2680
Entity
Organization
Contact information
Practice address
2196 MAIN ST STE A, DUNEDIN, FL 34698-5650
(727) 648-2680
(727) 648-2695
Mailing address
2196 MAIN ST STE A, DUNEDIN, FL 34698-5650
(727) 648-2680
(727) 648-2695
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH30500
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168277
PK
—
Enumeration date
03/09/2017
Last updated
03/13/2017
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