Organization
ST LUKE PHARMACY CORP
Active
Other names
ST Luke Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MUSALLAM (PRESIDENT)
(727) 754-7851
Entity
Organization
Contact information
Practice address
2019 GULF TO BAY BLVD, CLEARWATER, FL 33765-3703
(727) 754-7851
(727) 754-7852
Mailing address
2019 GULF TO BAY BLVD, CLEARWATER, FL 33765-3703
(727) 754-7851
(727) 754-7852
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH25416
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008099500
—
FL
01
—
2135137
PK
—
Enumeration date
05/11/2012
Last updated
07/13/2015
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