Provider Demographics
NPI:1003991399
Name:BROOKSVILLE DRUGS INC
Entity Type:Organization
Organization Name:BROOKSVILLE DRUGS INC
Other - Org Name:BROOKSVILLE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-304-2221
Mailing Address - Street 1:80 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601
Mailing Address - Country:US
Mailing Address - Phone:352-796-4975
Mailing Address - Fax:352-733-8307
Practice Address - Street 1:80 PONCE DE LEON BLVD.
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-796-4975
Practice Address - Fax:352-799-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 333600000X
FLPH67493336C0003X
FLFL67493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003463800Medicaid
1033202OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1033202OtherNCPDP PROVIDER IDENTIFICATION NUMBER