Provider Demographics
NPI:1811572407
Name:MA SANTOSHI LLC
Entity Type:Organization
Organization Name:MA SANTOSHI LLC
Other - Org Name:GREEN CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARDIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-268-3454
Mailing Address - Street 1:6600 NW 16TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4554
Mailing Address - Country:US
Mailing Address - Phone:201-575-2544
Mailing Address - Fax:
Practice Address - Street 1:23388 STATE ROAD 54 STE 104
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6937
Practice Address - Country:US
Practice Address - Phone:813-367-3752
Practice Address - Fax:813-467-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy