Provider Demographics
NPI:1477056901
Name:L AND N PHARMACY INC
Entity Type:Organization
Organization Name:L AND N PHARMACY INC
Other - Org Name:SUN & SEA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-786-3478
Mailing Address - Street 1:1849 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3128
Mailing Address - Country:US
Mailing Address - Phone:941-786-3208
Mailing Address - Fax:941-786-3478
Practice Address - Street 1:1849 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3128
Practice Address - Country:US
Practice Address - Phone:941-786-3208
Practice Address - Fax:941-786-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336M0002X
FLPH313613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1629347133Medicaid
2177317OtherPK