Healthcare Provider Details

I. General information

NPI: 1780103481
Provider Name (Legal Business Name): ELLENTON DISCOUNT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 US HIGHWAY 301 N
PARRISH FL
34219-8653
US

IV. Provider business mailing address

8324 US HIGHWAY 301 N
PARRISH FL
34219-8653
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-2233
  • Fax: 941-417-7144
Mailing address:
  • Phone: 941-444-2233
  • Fax: 941-417-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH29831
License Number StateFL

VIII. Authorized Official

Name: KUNJAL PATEL
Title or Position: PHARMACIST
Credential:
Phone: 941-444-2233