Provider Demographics
NPI:1437154879
Name:THE PRESCRIPTION SHOP, INC
Entity Type:Organization
Organization Name:THE PRESCRIPTION SHOP, INC
Other - Org Name:THE PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELP
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACIST
Authorized Official - Phone:727-822-4548
Mailing Address - Street 1:600 1ST AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3609
Mailing Address - Country:US
Mailing Address - Phone:727-822-4546
Mailing Address - Fax:727-821-5668
Practice Address - Street 1:600 1ST AVE N STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3609
Practice Address - Country:US
Practice Address - Phone:727-822-4546
Practice Address - Fax:727-821-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH00099633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109739301Medicaid
2007419OtherPK
FL109739300Medicaid
1284830001Medicare NSC