Healthcare Provider Details

I. General information

NPI: 1518554856
Provider Name (Legal Business Name): SRQ CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 S TAMIAMI TRL
SARASOTA FL
34231-3627
US

IV. Provider business mailing address

4201 S TAMIAMI TRL
SARASOTA FL
34231-3627
US

V. Phone/Fax

Practice location:
  • Phone: 941-750-1000
  • Fax:
Mailing address:
  • Phone: 941-750-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YELYZAVETA BRAMUROVA
Title or Position: PHARMACIST IN CHARGE / CEO
Credential: PHARMD RPH
Phone: 941-759-1000