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NPI Code Detail

MEDICARE: PARK SHORE DRUG INC

MEDICARE: PARK SHORE DRUG INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesPH13376FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285724492
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK SHORE DRUG INC
Provider Business Mailing Address
First Line : 600 ANSIN BLVD
Second Line :
City : HALLANDALE BEACH
State : FL
Zip : 33009-2118
Country : US
Telephone Number : 954-874-4646
Fax Number : 954-455-3718
Provider Business Practice Location Address
First Line : 600 ANSIN BLVD
Second Line :
City : HALLANDALE BEACH
State : FL
Zip : 33009-2118
Country : US
Telephone Number : 954-874-4646
Fax Number : 954-455-3718
Authorized Official
Title or Position : PRESIDENT
Name : MR. ROBERT D GILLIS
Credential : R.PH.
Telephone Number : 954-349-0369
Provider Enumeration Date : 10/16/2006
Last Update Date : 06/22/2012

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1235411786 — JAMES M GILLIS RPH, CPH
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1205118544 — DR. DAWN MICHELLE ROSALES R.PH., PHARM.D.
Practice Location Address:
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Directions to “PARK SHORE DRUG INC ” Practice Location

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