Provider Demographics
NPI:1063407971
Name:SUNCOAST RADIOPHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:SUNCOAST RADIOPHARMACY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-662-0693
Mailing Address - Street 1:3102 CHERRY PALM DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8314
Mailing Address - Country:US
Mailing Address - Phone:813-662-0693
Mailing Address - Fax:813-662-2814
Practice Address - Street 1:3102 CHERRY PALM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8314
Practice Address - Country:US
Practice Address - Phone:813-662-0693
Practice Address - Fax:813-662-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH23133333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy