Healthcare Provider Details

I. General information

NPI: 1255877312
Provider Name (Legal Business Name): SUBHAM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 15TH ST SE
STEINHATCHEE FL
32359-3101
US

IV. Provider business mailing address

102 9TH ST S E
STEINHATCHEE FL
32359
US

V. Phone/Fax

Practice location:
  • Phone: 352-498-0680
  • Fax: 352-498-0682
Mailing address:
  • Phone: 352-498-0680
  • Fax: 352-498-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH30542
License Number StateFL

VIII. Authorized Official

Name: CHIRAG PATEL
Title or Position: MANAGER/OWNER
Credential:
Phone: 352-498-0680