Healthcare Provider Details

I. General information

NPI: 1740732635
Provider Name (Legal Business Name): HEALTHCITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W MIDWAY RD STE 105
FORT PIERCE FL
34981-4823
US

IV. Provider business mailing address

4500 W MIDWAY RD STE 105
FORT PIERCE FL
34981-4823
US

V. Phone/Fax

Practice location:
  • Phone: 772-742-2886
  • Fax: 772-212-2747
Mailing address:
  • Phone: 772-742-2886
  • Fax: 772-212-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH30370
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SHYAM SUNDAR REDDY BUSIREDDY
Title or Position: OWNER
Credential:
Phone: 727-637-6644