Provider Demographics
NPI:1710342753
Name:PB GARDENS DRUGS LLC
Entity Type:Organization
Organization Name:PB GARDENS DRUGS LLC
Other - Org Name:GARDENS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-622-2141
Mailing Address - Street 1:10800 N MILITARY TRL
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6500
Mailing Address - Country:US
Mailing Address - Phone:561-622-2141
Mailing Address - Fax:561-622-7449
Practice Address - Street 1:4270C DESIGN CENTER DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4225
Practice Address - Country:US
Practice Address - Phone:561-622-2141
Practice Address - Fax:561-622-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
FLPH297843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016546900Medicaid
2155559OtherPK