Provider Demographics
NPI:1275958274
Name:PAC SHORES PHARMACY, LLC
Entity Type:Organization
Organization Name:PAC SHORES PHARMACY, LLC
Other - Org Name:SHORES VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAPNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARANIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:786-313-3018
Mailing Address - Street 1:9416 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2703
Mailing Address - Country:US
Mailing Address - Phone:786-313-3018
Mailing Address - Fax:786-334-5659
Practice Address - Street 1:9416 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2703
Practice Address - Country:US
Practice Address - Phone:786-313-3018
Practice Address - Fax:786-334-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH275713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7340850001Medicare NSC