Provider Demographics
NPI:1386725356
Name:PARK SHORE DRUG INC
Entity type:Organization
Organization Name:PARK SHORE DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-754-9508
Mailing Address - Street 1:9531 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2704
Mailing Address - Country:US
Mailing Address - Phone:305-754-9508
Mailing Address - Fax:305-754-3512
Practice Address - Street 1:9531 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2704
Practice Address - Country:US
Practice Address - Phone:305-754-9508
Practice Address - Fax:305-754-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH00008633336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy