Healthcare Provider Details

I. General information

NPI: 1891971198
Provider Name (Legal Business Name): POPE SHENOUDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 US HIGHWAY 19
HOLIDAY FL
34691-4351
US

IV. Provider business mailing address

2228 US HIGHWAY 19
HOLIDAY FL
34691-4351
US

V. Phone/Fax

Practice location:
  • Phone: 727-934-1300
  • Fax: 727-934-1313
Mailing address:
  • Phone: 727-934-1300
  • Fax: 727-934-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23208
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE HANNA
Title or Position: OWNER
Credential: PHRMD
Phone: 201-400-7327