Healthcare Provider Details

I. General information

NPI: 1902670912
Provider Name (Legal Business Name): SHORECARE VACCINES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31182 VICTOR RD
MILLVILLE DE
19967-6720
US

IV. Provider business mailing address

31182 VICTOR RD
MILLVILLE DE
19967-6720
US

V. Phone/Fax

Practice location:
  • Phone: 443-617-2576
  • Fax:
Mailing address:
  • Phone: 443-617-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL KANTOR
Title or Position: OWNER
Credential: PHARM D.
Phone: 443-617-2576