Healthcare Provider Details

I. General information

NPI: 1346565645
Provider Name (Legal Business Name): CK PHARMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 N PINELLAS AVE
TARPON SPRINGS FL
34689-5780
US

IV. Provider business mailing address

1933 N PINELLAS AVE
TARPON SPRINGS FL
34689-5780
US

V. Phone/Fax

Practice location:
  • Phone: 727-944-5800
  • Fax: 727-944-5844
Mailing address:
  • Phone: 727-944-5800
  • Fax: 727-944-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24489
License Number StateFL

VIII. Authorized Official

Name: MR. CHETAN SHAH
Title or Position: PHARMACY MANAGER/OWNER
Credential:
Phone: 813-410-3791