Provider Demographics
NPI:1518024116
Name:DRUG STORE AND MORE INC
Entity Type:Organization
Organization Name:DRUG STORE AND MORE INC
Other - Org Name:DRUGSTOREANDMORE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTEET
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:561-842-4456
Mailing Address - Street 1:8305 GARDEN RD
Mailing Address - Street 2:SUITE1-3
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1709
Mailing Address - Country:US
Mailing Address - Phone:561-842-4456
Mailing Address - Fax:561-842-9515
Practice Address - Street 1:8305 GARDEN RD
Practice Address - Street 2:SUITE 1-3
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1709
Practice Address - Country:US
Practice Address - Phone:561-842-4456
Practice Address - Fax:561-842-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16829333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021793000Medicaid
FL1280600001Medicare NSC