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General NPI Number Information
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NPI Number | 1750654711
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Entity Type | Organization
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Legal Business Name | SA DRUGS LLC
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 115 NW SANTA FE BLVD
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City | HIGH SPRINGS
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State | FL
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Zip | 32643-4301
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Country | US
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Telephone | 386-454-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 13207 THOMASVILLE CIR APT D
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City | TAMPA
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State | FL
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Zip | 33617-9507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RAJASEKARAN MANI
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Credential |
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Telephone | 239-246-0796
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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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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25943
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License Number State | FL
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