Provider Demographics
NPI:1427248392
Name:PRESCRIPTION SHOPPES LLC
Entity type:Organization
Organization Name:PRESCRIPTION SHOPPES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:V
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH, MBA
Authorized Official - Phone:407-847-2424
Mailing Address - Street 1:114 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5714
Mailing Address - Country:US
Mailing Address - Phone:407-847-2424
Mailing Address - Fax:407-483-0265
Practice Address - Street 1:114 BROADWAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5714
Practice Address - Country:US
Practice Address - Phone:407-847-2424
Practice Address - Fax:407-483-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH190693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1006421OtherNCPDP #
FLBP8178813OtherDEA #
FL1006421OtherNCPDP #