Healthcare Provider Details

I. General information

NPI: 1710352075
Provider Name (Legal Business Name): PINELLAS PARK DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 66TH ST N
PINELLAS PARK FL
33781-5026
US

IV. Provider business mailing address

6280 66TH STREET N.
PINELLAS PARK FL
33781
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-4203
  • Fax: 888-239-8423
Mailing address:
  • Phone: 727-544-4203
  • Fax: 727-544-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH29591
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALPESH PATEL
Title or Position: OWNER
Credential:
Phone: 813-304-2221