Provider Demographics
NPI:1114384187
Name:SARASOTA DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:SARASOTA DISCOUNT PHARMACY INC
Other - Org Name:SARASOTA DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOZEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOBRIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-444-6888
Mailing Address - Street 1:11O N LIVE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237
Mailing Address - Country:US
Mailing Address - Phone:941-444-6888
Mailing Address - Fax:941-444-1313
Practice Address - Street 1:110 N LIME AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6122
Practice Address - Country:US
Practice Address - Phone:941-444-6888
Practice Address - Fax:941-444-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 333600000X
FLPH298893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159325OtherPK
FL017090400Medicaid