Healthcare Provider Details

I. General information

NPI: 1396761854
Provider Name (Legal Business Name): TREASURE COAST SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4708
US

IV. Provider business mailing address

1114 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4708
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-5316
  • Fax: 772-463-5319
Mailing address:
  • Phone: 772-463-5316
  • Fax: 772-463-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22113
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER DEL TORO
Title or Position: OWNER AND RPH
Credential: PHARMD
Phone: 772-463-5316