Organization
PARK SHORE DRUG INC
Active
Other names
Park Shore Pharmacon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT D GILLIS R.PH. (PRESIDENT.)
(954) 874-4646
Entity
Organization
Contact information
Practice address
600 ANSIN BLVD, HALLANDALE BEACH, FL 33009-2118
(954) 874-4646
(954) 455-1378
Mailing address
600 ANSIN BLVD, HALLANDALE BEACH, FL 33009-2118
(954) 874-4646
(954) 455-1378
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PH13376
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
671982198
—
FL
Enumeration date
10/04/2006
Last updated
06/21/2012
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