Healthcare Provider Details

I. General information

NPI: 1760541866
Provider Name (Legal Business Name): TREASURE ISLAND PHARMACY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 79TH STREET CSWY
NORTH BAY VILLAGE FL
33141-4132
US

IV. Provider business mailing address

1630 79TH STREET CSWY
NORTH BAY VILLAGE FL
33141-4132
US

V. Phone/Fax

Practice location:
  • Phone: 305-868-6144
  • Fax: 305-861-1607
Mailing address:
  • Phone: 305-868-6144
  • Fax: 305-861-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH25262
License Number StateFL

VIII. Authorized Official

Name: JAQUELINE ROSSI
Title or Position: PRESIDENT
Credential:
Phone: 305-868-6144