Healthcare Provider Details

I. General information

NPI: 1902776594
Provider Name (Legal Business Name): SRQ VACCINATION CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 SAWYER RD
SARASOTA FL
34233-1272
US

IV. Provider business mailing address

4020 SAWYER RD
SARASOTA FL
34233-1272
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-7475
  • Fax:
Mailing address:
  • Phone: 941-366-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: TAMER HANY GUIRGUIS
Title or Position: PHARMACIST-IN-CHARGE/OWNER
Credential: PHARM.D
Phone: 941-424-5041