Provider Demographics
NPI:1578814539
Name:LITTLEROADPHARMACY LLC
Entity Type:Organization
Organization Name:LITTLEROADPHARMACY LLC
Other - Org Name:LITTLE ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-213-5173
Mailing Address - Street 1:4211 LITTLE RD
Mailing Address - Street 2:UNIT # 4
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1606
Mailing Address - Country:US
Mailing Address - Phone:727-372-5222
Mailing Address - Fax:727-372-5225
Practice Address - Street 1:4211 LITTLE RD
Practice Address - Street 2:UNIT # 4
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1606
Practice Address - Country:US
Practice Address - Phone:727-372-5222
Practice Address - Fax:727-372-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-30
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH263623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5712016OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL6782100Medicaid