Provider Demographics
NPI:1467709709
Name:PASCO PHARMACY INC
Entity Type:Organization
Organization Name:PASCO PHARMACY INC
Other - Org Name:FLORIDA WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRUTIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-966-0177
Mailing Address - Street 1:9332 STATE ROAD 54 STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1810
Mailing Address - Country:US
Mailing Address - Phone:813-991-9500
Mailing Address - Fax:813-991-9600
Practice Address - Street 1:9332 STATE ROAD 54 STE 205
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1810
Practice Address - Country:US
Practice Address - Phone:813-991-9500
Practice Address - Fax:813-991-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH26197333600000X
VT3601198923336C0004X
NHNR13183336C0004X
MDPO70883336C0004X
CTPCN.00029523336C0004X
NJ28RO001108003336C0004X
OHNRP022608200.023336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147577OtherPK