=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710352075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINELLAS PARK DRUGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2015
-----------------------------------------------------
Last Update Date | 10/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6280 66TH ST N
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33781-5026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-544-4203
-----------------------------------------------------
Fax | 888-239-8423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6280 66TH STREET N.
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-544-4203
-----------------------------------------------------
Fax | 727-544-5200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALPESH PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-304-2221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PH29591
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WD0400X
-----------------------------------------------------
Taxonomy Name | Diabetes Educator Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------