Provider Demographics
NPI:1891242798
Name:EZ RX BONITA SPRINGS LLC
Entity Type:Organization
Organization Name:EZ RX BONITA SPRINGS LLC
Other - Org Name:MY CHOICE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-301-5058
Mailing Address - Street 1:9300 CONROY WINDERMERE RD UNIT 216
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5009
Mailing Address - Country:US
Mailing Address - Phone:239-301-5058
Mailing Address - Fax:239-790-5182
Practice Address - Street 1:13141 MCGREGOR BLVD STE 7
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5926
Practice Address - Country:US
Practice Address - Phone:239-301-5058
Practice Address - Fax:239-790-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH30329333600000X
3336C0003X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163870OtherPK