Provider Demographics
NPI:1710280458
Name:BISHT LLC
Entity Type:Organization
Organization Name:BISHT LLC
Other - Org Name:DESOTO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-637-2922
Mailing Address - Street 1:301 N BREVARD AVE
Mailing Address - Street 2:STE E
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-4501
Mailing Address - Country:US
Mailing Address - Phone:863-491-7415
Mailing Address - Fax:863-491-7416
Practice Address - Street 1:301 N BREVARD AVE
Practice Address - Street 2:STE E
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-4501
Practice Address - Country:US
Practice Address - Phone:863-491-7415
Practice Address - Fax:863-491-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH251243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5703308OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5703308OtherNCPDP PROVIDER IDENTIFICATION NUMBER