Healthcare Provider Details

I. General information

NPI: 1316700941
Provider Name (Legal Business Name): SKP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 GULFPORT BLVD S
GULFPORT FL
33707-4942
US

IV. Provider business mailing address

5004 GULFPORT BLVD S
GULFPORT FL
33707-4942
US

V. Phone/Fax

Practice location:
  • Phone: 727-223-1075
  • Fax: 727-388-8217
Mailing address:
  • Phone: 727-223-1075
  • Fax: 727-388-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TAPAN PATEL
Title or Position: BUSINESS PARTNER
Credential: RPH
Phone: 631-672-0456