Provider Demographics
NPI:1093354797
Name:DAN'S PHARMACY INC DBA CARROLLWOOD COMPOUNDING CENTER
Entity Type:Organization
Organization Name:DAN'S PHARMACY INC DBA CARROLLWOOD COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:FUCARINO
Authorized Official - Suffix:
Authorized Official - Credentials:B PHARM
Authorized Official - Phone:813-391-3009
Mailing Address - Street 1:11775 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3503
Mailing Address - Country:US
Mailing Address - Phone:813-961-8798
Mailing Address - Fax:813-961-9800
Practice Address - Street 1:11775 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3503
Practice Address - Country:US
Practice Address - Phone:813-961-8798
Practice Address - Fax:813-961-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy