Organization
PINE BROOK PHARMACY LTC LLC
Active
Other names
PINE BROOK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GAUTAM THAKKAR RPH (OWNER)
(813) 454-3500
Entity
Organization
Contact information
Practice address
10507 SPRING HILL DR STE 101, SPRING HILL, FL 34608-5047
(813) 454-3500
Mailing address
19107 HARBOR COVE CT, LUTZ, FL 33558-9702
(813) 454-3500
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
10/17/2022
Last updated
10/17/2022
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