Healthcare Provider Details

I. General information

NPI: 1467709709
Provider Name (Legal Business Name): PASCO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 STATE ROAD 54 STE 205
NEW PORT RICHEY FL
34655-1810
US

IV. Provider business mailing address

9332 STATE ROAD 54 STE 205
NEW PORT RICHEY FL
34655-1810
US

V. Phone/Fax

Practice location:
  • Phone: 813-991-9500
  • Fax: 813-991-9600
Mailing address:
  • Phone: 813-991-9500
  • Fax: 813-991-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH26197
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number360119892
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberNR1318
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPO7088
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPCN.0002952
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RO00110800
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberNRP022608200.02
License Number StateOH

VIII. Authorized Official

Name: KRUTIKA PATEL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 813-966-0177