Provider Demographics
NPI:1427378488
Name:HARHAR MAHADEV LLC
Entity Type:Organization
Organization Name:HARHAR MAHADEV LLC
Other - Org Name:PALM HARBOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:MIRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-793-7672
Mailing Address - Street 1:34650 US HIGHWAY 19 N STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2155
Mailing Address - Country:US
Mailing Address - Phone:727-787-2273
Mailing Address - Fax:727-787-0044
Practice Address - Street 1:34650 US HIGHWAY 19 N STE 101
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2155
Practice Address - Country:US
Practice Address - Phone:727-787-2273
Practice Address - Fax:727-787-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH246863336C0003X
FL3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200165706Medicaid
2125329OtherPK