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General NPI Number Information
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NPI Number | 1396263299
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Entity Type | Organization
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Legal Business Name | PEBBLEBROOK INC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 06/05/2021
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Provider Practice Location Address
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Address Line | 4861 GOLDEN GATE PKWY
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City | NAPLES
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State | FL
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Zip | 34116-6953
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Country | US
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Telephone | 239-331-3836
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Fax | 239-692-8213
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Provider Business Mailing Address
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Address Line | 15215 COLLIER BLVD STE 308
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City | NAPLES
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State | FL
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Zip | 34119-6835
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Country | US
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Telephone | 239-331-3836
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Fax | 239-692-8213
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Authorized Official
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Title or Position | AUTHORIZED PERSON
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Name | MR. SURESH CHAUDHARI
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Credential | RPH
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Telephone | 239-331-3836
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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 | PH30941
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License Number State | FL
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