Organization
PARK SHORE DRUG INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT D GILLIS R.PH. (PHARMACIST, PRESIDENT)
(954) 874-4646
Entity
Organization
Contact information
Practice address
600 ANSIN BLVD, HALLANDALE BEACH, FL 33009-2118
(954) 874-4646
(954) 455-1378
Mailing address
600 ANSIN BLVD, HALLANDALE BEACH, FL 33009-2118
(954) 874-4646
(954) 455-1378
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PH13376
FL
3336L0003X
Long Term Care Pharmacy
Primary
PH13376
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018477700
—
FL
01
—
018477701
DME, MEDICAID PHARMACY
FL
05
—
018614500
—
FL
01
—
1011915
NCPDP #
FL
01
—
P1723B
MEDICARE LOCAL CARRIER #/PTAN
FL
Enumeration date
05/10/2006
Last updated
12/05/2017
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