Provider Demographics
NPI:1013434265
Name:THREE OAKS PHARMACY, INC.
Entity Type:Organization
Organization Name:THREE OAKS PHARMACY, INC.
Other - Org Name:BONITA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAIVIK
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-221-8884
Mailing Address - Street 1:10347 BONITA BEACH RD SE UNIT 117
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4817
Mailing Address - Country:US
Mailing Address - Phone:239-221-8884
Mailing Address - Fax:
Practice Address - Street 1:10347 BONITA BEACH RD SE UNIT 117
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4817
Practice Address - Country:US
Practice Address - Phone:973-461-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH309363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy