Organization
BAYSHORE PHARMACY
Active
Other names
Bayshore Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH SERRAGO (PHARMACIST/CHIEF)
(772) 344-0410
Entity
Organization
Contact information
Practice address
1026 SW BAYSHORE BLVD, PORT SAINT LUCIE, FL 34983-2400
(772) 344-0410
(772) 344-0409
Mailing address
1026 SW BAYSHORE BLVD, PORT SAINT LUCIE, FL 34983-2400
(772) 344-0410
(772) 344-0409
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26774
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101097200
—
FL
01
—
2140977
PK
—
Enumeration date
07/19/2013
Last updated
03/09/2017
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