Healthcare Provider Details

I. General information

NPI: 1023280765
Provider Name (Legal Business Name): DAYTONA DISCOUNT PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BEVILLE RD STE - D
SOUTH DAYTONA FL
32119-1858
US

IV. Provider business mailing address

815 BEVILLE RD STE - D
SOUTH DAYTONA FL
32119-1858
US

V. Phone/Fax

Practice location:
  • Phone: 386-322-5969
  • Fax: 386-322-0626
Mailing address:
  • Phone: 386-322-5969
  • Fax: 386-322-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23268
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MANISH H PATEL
Title or Position: PHARMACIST
Credential: R.PH.
Phone: 386-322-5969