Healthcare Provider Details

I. General information

NPI: 1083352025
Provider Name (Legal Business Name): SUNCOAST COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16621 LAGOON SHORE BLVD
WIMAUMA FL
33598-4177
US

IV. Provider business mailing address

PO BOX 1349
RUSKIN FL
33575-1349
US

V. Phone/Fax

Practice location:
  • Phone: 813-630-3649
  • Fax: 813-626-4138
Mailing address:
  • Phone: 813-630-3649
  • Fax: 813-626-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFF HUNT
Title or Position: PHARMACY DIRECTOR
Credential: PHARMACIST
Phone: 813-349-7959