Provider Demographics
NPI:1124766159
Name:MERRITT ISLAND PHARMACY
Entity type:Organization
Organization Name:MERRITT ISLAND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:RATILAL
Authorized Official - Last Name:DHADUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-454-0911
Mailing Address - Street 1:35 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3476
Mailing Address - Country:US
Mailing Address - Phone:321-454-0911
Mailing Address - Fax:321-459-2479
Practice Address - Street 1:35 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3476
Practice Address - Country:US
Practice Address - Phone:321-454-0911
Practice Address - Fax:321-459-2479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERRITT ISLAND PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy