Healthcare Provider Details

I. General information

NPI: 1225186497
Provider Name (Legal Business Name): PRESCRIPTION SHOP OF STUART, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 COLORADO AVE
STUART FL
34994-3016
US

IV. Provider business mailing address

622 COLORADO AVE
STUART FL
34994-3016
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-3443
  • Fax: 772-287-0087
Mailing address:
  • Phone: 772-287-3443
  • Fax: 772-287-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH0001444
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT BERNARD TAYLOR
Title or Position: PRESIDENT
Credential: RPH
Phone: 772-287-3443