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General NPI Number Information
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NPI Number | 1215208616
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Entity Type | Organization
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Legal Business Name | FLORIDA KERELOS LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 9320 US HIGHWAY 19
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City | PORT RICHEY
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State | FL
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Zip | 34668-4772
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Country | US
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Telephone | 727-842-3400
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Fax | 727-842-3800
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Provider Business Mailing Address
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Address Line | 2690 CRYSTAL CIR
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City | DUNEDIN
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State | FL
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Zip | 34698-2409
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Country | US
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Telephone | 727-331-9806
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Fax |
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Authorized Official
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Title or Position | RPH
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Name | NASHAAT BOUTROS
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Credential |
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Telephone | 727-842-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25886
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License Number State | FL
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