Provider Demographics
NPI:1316098395
Name:PINE ISLAND DRUGS INC
Entity type:Organization
Organization Name:PINE ISLAND DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SITORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVAZODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-424-3784
Mailing Address - Street 1:8844 W STATE ROAD 84
Mailing Address - Street 2:UNIT B
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-424-3784
Mailing Address - Fax:954-424-3412
Practice Address - Street 1:8844 W STATE ROAD 84
Practice Address - Street 2:UNIT B
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4455
Practice Address - Country:US
Practice Address - Phone:954-424-3784
Practice Address - Fax:954-424-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0004X
FLPH137743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2009615OtherPK
FL103446400Medicaid