Provider Demographics
NPI:1841383288
Name:LURDS INC
Entity Type:Organization
Organization Name:LURDS INC
Other - Org Name:DOCTORS CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DME OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARDI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN RENSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-697-1090
Mailing Address - Street 1:7455 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:BAYONET POINT
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6714
Mailing Address - Country:US
Mailing Address - Phone:727-697-1090
Mailing Address - Fax:727-697-1074
Practice Address - Street 1:6518 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3905
Practice Address - Country:US
Practice Address - Phone:727-844-7040
Practice Address - Fax:727-842-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH193913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2015772OtherPK
FL212547100Medicaid
2015772OtherPK