Provider Demographics
NPI:1942489380
Name:PELOTS PHARMACY
Entity Type:Organization
Organization Name:PELOTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:941-748-8130
Mailing Address - Street 1:831 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1243
Mailing Address - Country:US
Mailing Address - Phone:941-748-8130
Mailing Address - Fax:941-749-5406
Practice Address - Street 1:831 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1243
Practice Address - Country:US
Practice Address - Phone:941-748-8130
Practice Address - Fax:941-749-5406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELOTS PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0732610001Medicare NSC