Healthcare Provider Details

I. General information

NPI: 1003837345
Provider Name (Legal Business Name): PELOT'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 MANATEE AVE E
BRADENTON FL
34208-1243
US

IV. Provider business mailing address

831 MANATEE AVE E
BRADENTON FL
34208-1243
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-8130
  • Fax: 941-749-5406
Mailing address:
  • Phone: 941-748-8130
  • Fax: 941-749-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0012705
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT L PELOT
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 941-748-8130