Provider Demographics
NPI:1326334350
Name:TARGET
Entity Type:Organization
Organization Name:TARGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:239-829-2640
Mailing Address - Street 1:1890 NE PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1733
Mailing Address - Country:US
Mailing Address - Phone:239-829-2640
Mailing Address - Fax:239-829-2643
Practice Address - Street 1:1890 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1733
Practice Address - Country:US
Practice Address - Phone:239-829-2640
Practice Address - Fax:239-829-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22917333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy