Healthcare Provider Details

I. General information

NPI: 1750654711
Provider Name (Legal Business Name): SA DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NW SANTA FE BLVD
HIGH SPRINGS FL
32643-4301
US

IV. Provider business mailing address

13207 THOMASVILLE CIR APT D
TAMPA FL
33617-9507
US

V. Phone/Fax

Practice location:
  • Phone: 386-454-7768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25943
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAJASEKARAN MANI
Title or Position: MANAGER
Credential:
Phone: 239-246-0796