Healthcare Provider Details

I. General information

NPI: 1063438075
Provider Name (Legal Business Name): SUNCOAST VITAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 SPRING HILL DR STE E
SPRING HILL FL
34606-4543
US

IV. Provider business mailing address

5330 SPRING HILL DR STE E
SPRING HILL FL
34606-4543
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-1866
  • Fax: 352-686-1840
Mailing address:
  • Phone: 352-686-1866
  • Fax: 325-686-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH11906
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH11906
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000483800
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerMEDICAID PHARMACY
# 2
Identifier1078559
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER
# 3
Identifier000483801
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerMEDICAID DME

VIII. Authorized Official

Name: CHIRAG AMIN
Title or Position: PHARMACIST
Credential:
Phone: 352-686-1866