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General NPI Number Information
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NPI Number | 1487276663
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTHCARE ALLIANCE
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 3510 DR MARTIN LUTHER KING BLVD STE 1
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City | FORT MYERS
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State | FL
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Zip | 33916-4608
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Country | US
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Telephone | 239-826-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 DR MARTIN LUTHER KING BLVD STE 1
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City | FORT MYERS
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State | FL
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Zip | 33916-4608
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Country | US
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Telephone | 239-488-2580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHADREKA MCINTOSH
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Credential | PHARM.D.
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Telephone | 239-488-2580
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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 |
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License Number State |
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