Organization
PINE BROOK PHARMACY LLC
Active
Other names
PINE BROOK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HEENA THAKKAR (PRESIDENT)
(813) 454-3426
Entity
Organization
Contact information
Practice address
14111 CORTEZ BLVD, BROOKSVILLE, FL 34613-2707
(352) 610-4347
(352) 610-4349
Mailing address
14111 CORTEZ BLVD, BROOKSVILLE, FL 34613-2707
(352) 610-4347
(352) 610-4349
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH24082
FL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120453
PK
—
05
—
6669650001
—
FL
Enumeration date
05/28/2009
Last updated
01/27/2022
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