Provider Demographics
NPI:1326310004
Name:OSCEOLA PHARMACY OF VERO BEACH INC
Entity Type:Organization
Organization Name:OSCEOLA PHARMACY OF VERO BEACH INC
Other - Org Name:OSCEOLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-3660
Mailing Address - Street 1:1635 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0435
Mailing Address - Country:US
Mailing Address - Phone:772-562-3660
Mailing Address - Fax:772-562-3650
Practice Address - Street 1:1635 14TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0435
Practice Address - Country:US
Practice Address - Phone:772-562-3660
Practice Address - Fax:772-562-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH258273336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708853OtherNCPDP PROVIDER IDENTIFICATION NUMBER