Provider Demographics
NPI:1194868307
Name:DAVIDSON DRUGS INC
Entity Type:Organization
Organization Name:DAVIDSON DRUGS INC
Other - Org Name:DAVIDSON DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-1515
Mailing Address - Street 1:5124 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1637
Mailing Address - Country:US
Mailing Address - Phone:941-349-1111
Mailing Address - Fax:941-312-0631
Practice Address - Street 1:5124 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-1637
Practice Address - Country:US
Practice Address - Phone:941-349-1111
Practice Address - Fax:941-312-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH14053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101419600Medicaid
2006959OtherPK