Provider Demographics
NPI:1760541866
Name:TREASURE ISLAND PHARMACY CARE INC
Entity Type:Organization
Organization Name:TREASURE ISLAND PHARMACY CARE INC
Other - Org Name:TREASURE ISLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-868-6144
Mailing Address - Street 1:1630 79TH STREET CSWY
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4132
Mailing Address - Country:US
Mailing Address - Phone:305-868-6144
Mailing Address - Fax:305-861-1607
Practice Address - Street 1:1630 79TH STREET CSWY
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4132
Practice Address - Country:US
Practice Address - Phone:305-868-6144
Practice Address - Fax:305-861-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25262333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032078100Medicaid
FL032078101Medicaid
2128083OtherPK
5976380001Medicare NSC