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General NPI Number Information
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NPI Number | 1710381694
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Entity Type | Organization
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Legal Business Name | SOUTHSHORE PHARMACY, INC.
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 13127 KINGS LAKE DR. UNIT 102
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City | GIBSONTON
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State | FL
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Zip | 33534-3958
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Country | US
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Telephone | 813-672-9600
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Fax | 813-613-1968
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Provider Business Mailing Address
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Address Line | 13127 KINGS LAKE DR. UNIT 102
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City | GIBSONTON
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State | FL
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Zip | 33534-3958
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Country | US
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Telephone | 813-672-9600
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Fax | 813-613-1968
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID A FLAX
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Credential |
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Telephone | 863-712-3064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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