Provider Demographics
NPI:1508066739
Name:PRESCRIPTION SHOPPES LLC
Entity Type:Organization
Organization Name:PRESCRIPTION SHOPPES LLC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:V
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH, MBA
Authorized Official - Phone:407-847-2424
Mailing Address - Street 1:864 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4770
Mailing Address - Country:US
Mailing Address - Phone:386-253-1691
Mailing Address - Fax:386-253-1693
Practice Address - Street 1:864 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4770
Practice Address - Country:US
Practice Address - Phone:386-253-1691
Practice Address - Fax:386-253-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH193313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026053300Medicaid
FL026053301Medicaid
FL1068522OtherNCPDP #
FLBP8350718OtherDEA #
FLBP8350718OtherDEA #