Provider Demographics
NPI: | 1346565645 |
---|---|
Name: | CK PHARMA |
Entity Type: | Organization |
Organization Name: | CK PHARMA |
Other - Org Name: | ANCLOTE PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PHARMACY MANAGER/OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHETAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHAH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 813-410-3791 |
Mailing Address - Street 1: | 1933 N PINELLAS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | TARPON SPRINGS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34689-5780 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 727-944-5800 |
Mailing Address - Fax: | 727-944-5844 |
Practice Address - Street 1: | 1933 N PINELLAS AVE |
Practice Address - Street 2: | |
Practice Address - City: | TARPON SPRINGS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34689-5780 |
Practice Address - Country: | US |
Practice Address - Phone: | 727-944-5800 |
Practice Address - Fax: | 727-944-5844 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-03-30 |
Last Update Date: | 2010-03-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PH24489 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |