Provider Demographics
NPI:1316294093
Name:SOUTH OCEAN PHARMACY INC
Entity type:Organization
Organization Name:SOUTH OCEAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MIPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-449-2887
Mailing Address - Street 1:2875 S OCEAN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-5590
Mailing Address - Country:US
Mailing Address - Phone:561-721-4359
Mailing Address - Fax:561-721-4369
Practice Address - Street 1:2875 S OCEAN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-5590
Practice Address - Country:US
Practice Address - Phone:561-721-4359
Practice Address - Fax:561-721-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH262753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136401OtherPK