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General NPI Number Information
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NPI Number | 1922236421
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Entity Type | Organization
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Legal Business Name | DUTTA LLC
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 1839 CENTRAL AVE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8900
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Country | US
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Telephone | 727-894-3001
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Fax | 727-894-3000
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Provider Business Mailing Address
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Address Line | 1839 CENTRAL AVE U 101
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8900
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Country | US
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Telephone | 727-894-3001
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Fax | 727-894-3000
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | VISHAL MALKAN
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Credential |
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Telephone | 813-285-9365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24140
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License Number State | FL
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