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General NPI Number Information
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NPI Number | 1225180722
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER PHARMACY, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3721 10TH CT
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City | VERO BEACH
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State | FL
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Zip | 32960-6559
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Country | US
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Telephone | 772-567-2555
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Fax | 772-567-0013
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Provider Business Mailing Address
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Address Line | 3721 10TH CT
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City | VERO BEACH
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State | FL
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Zip | 32960-6559
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Country | US
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Telephone | 772-567-2555
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Fax | 772-567-0013
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY MICHAEL DECRESCENZO
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Credential | R.PH.
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Telephone | 772-567-2555
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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 | PH12565
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PH19077
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License Number State | FL
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