Provider Demographics
NPI:1265820807
Name:PEARL SHAH LLC
Entity Type:Organization
Organization Name:PEARL SHAH LLC
Other - Org Name:SAINT PETERSBURG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-389-5900
Mailing Address - Street 1:6399 38TH AVE N
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1647
Mailing Address - Country:US
Mailing Address - Phone:727-258-8354
Mailing Address - Fax:
Practice Address - Street 1:6399 38TH AVE N STE A5
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1651
Practice Address - Country:US
Practice Address - Phone:727-201-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH276593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149350OtherPK
2149350OtherPK