Provider Demographics
NPI:1154727519
Name:FORT PIERCE DISCOUNT PHARMACY, INC.
Entity type:Organization
Organization Name:FORT PIERCE DISCOUNT PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:772-577-6469
Mailing Address - Street 1:1727 OKEECHOBEE RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-3945
Mailing Address - Country:US
Mailing Address - Phone:772-577-6469
Mailing Address - Fax:772-577-6657
Practice Address - Street 1:1727 OKEECHOBEE RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-3945
Practice Address - Country:US
Practice Address - Phone:772-873-3743
Practice Address - Fax:772-577-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH286823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148672OtherPK