Provider Demographics
NPI:1710665617
Name:PSG OF SARASOTA LLC
Entity Type:Organization
Organization Name:PSG OF SARASOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-650-5802
Mailing Address - Street 1:5315 AVION PARK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1461
Mailing Address - Country:US
Mailing Address - Phone:844-650-5802
Mailing Address - Fax:844-277-0049
Practice Address - Street 1:140 NORTHWAY CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4916
Practice Address - Country:US
Practice Address - Phone:844-650-5802
Practice Address - Fax:844-277-0049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSG OF SARASOTA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy