Provider Demographics
NPI:1346760683
Name:MARCO ISLAND PHARMACY 2 LLC
Entity Type:Organization
Organization Name:MARCO ISLAND PHARMACY 2 LLC
Other - Org Name:GOLDEN GATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-315-4821
Mailing Address - Street 1:5475 GOLDEN GATE PKWY STE 5W
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7529
Mailing Address - Country:US
Mailing Address - Phone:239-315-4823
Mailing Address - Fax:239-315-4824
Practice Address - Street 1:5475 GOLDEN GATE PKWY STE 5W
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7529
Practice Address - Country:US
Practice Address - Phone:239-315-4823
Practice Address - Fax:239-315-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC12895207Q00000X
333600000X
FLPH308123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170086OtherPK