Organization
ECKERDS PHARMACY LLC
Active
Other names
VISTARA SPECIALTY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BHAVESHKUMAR PATEL (PIC)
(813) 900-4995
Entity
Organization
Contact information
Practice address
4404 66TH ST N, KENNETH CITY, FL 33709-4922
(727) 513-1107
(727) 513-1109
Mailing address
4404 66TH ST N, KENNETH CITY, FL 33709-4922
(727) 513-1107
(727) 513-1109
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101899100
—
FL
01
—
PH31757
LICENSE
FL
Enumeration date
11/20/2018
Last updated
01/18/2024
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