Healthcare Provider Details

I. General information

NPI: 1851673214
Provider Name (Legal Business Name): MISIR DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8795 TAMIAMI TRL E UNIT 201
NAPLES FL
34113-3313
US

IV. Provider business mailing address

8795 TAMIAMI TRL E UNIT 201
NAPLES FL
34113-3313
US

V. Phone/Fax

Practice location:
  • Phone: 239-403-0060
  • Fax: 239-403-0065
Mailing address:
  • Phone: 239-403-0060
  • Fax: 239-403-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25701
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHIVSANKAR MISIR
Title or Position: OWNER
Credential: PHARMACIST
Phone: 239-403-0060