Organization
TOTAL HEALTHCARE ALLIANCE
Active
Other names
SOZO WELLNESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHADREKA MCINTOSH PHARM.D. (OWNER)
(239) 488-2580
Entity
Organization
Contact information
Practice address
3510 DR MARTIN LUTHER KING BLVD STE 1, FORT MYERS, FL 33916-4608
(239) 826-4192
Mailing address
3510 DR MARTIN LUTHER KING BLVD STE 1, FORT MYERS, FL 33916-4608
(239) 488-2580
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108203100
—
FL
Enumeration date
05/11/2020
Last updated
02/25/2022
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