MEDICARE: SHUBHOM HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH24996	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2127229	OTHER		PK

General Provider Information

NPI Number	:	1952611329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHUBHOM HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3600 S TUTTLE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-6407
Country	:	US
Telephone Number	:	941-556-9622
Fax Number	:	941-556-9623

Provider Business Practice Location Address
First Line	:	3600 S TUTTLE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-6407
Country	:	US
Telephone Number	:	941-556-9622
Fax Number	:	941-556-9623

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	BHUMIN PATEL
Credential	:
Telephone Number	:	941-773-4460

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	06/17/2019

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Directions to “SHUBHOM HEALTHCARE LLC ” Practice Location

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