Healthcare Provider Details

I. General information

NPI: 1013237668
Provider Name (Legal Business Name): IMMOKALEE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PIPER BLVD UNIT 12
NAPLES FL
34110
US

IV. Provider business mailing address

2812 W. MLK JR BLVD
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-6123
  • Fax: 239-658-6127
Mailing address:
  • Phone: 813-328-3970
  • Fax: 239-658-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number30304
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HARKIKKUMAR PATEL
Title or Position: OWNER
Credential:
Phone: 813-328-3970