Provider Demographics
NPI:1851673214
Name:MISIR DRUGS LLC
Entity type:Organization
Organization Name:MISIR DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIVSANKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MISIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:239-403-0060
Mailing Address - Street 1:8795 TAMIAMI TRL E
Mailing Address - Street 2:UNIT 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-3313
Mailing Address - Country:US
Mailing Address - Phone:239-403-0060
Mailing Address - Fax:239-403-0065
Practice Address - Street 1:8795 TAMIAMI TRL E
Practice Address - Street 2:UNIT 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-3313
Practice Address - Country:US
Practice Address - Phone:239-403-0060
Practice Address - Fax:239-403-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X, 332B00000X, 333600000X
FLPH257013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132610OtherPK
FL004239800Medicaid