Provider Demographics
NPI:1396761854
Name:TREASURE COAST SPECIALTY PHARMACY INC
Entity type:Organization
Organization Name:TREASURE COAST SPECIALTY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND RPH
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:772-463-5316
Mailing Address - Street 1:1114 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4708
Mailing Address - Country:US
Mailing Address - Phone:772-463-5316
Mailing Address - Fax:772-463-5319
Practice Address - Street 1:1114 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4708
Practice Address - Country:US
Practice Address - Phone:772-463-5316
Practice Address - Fax:772-463-5319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
FLPH221133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031666100Medicaid
1020128OtherNCPDP PROVIDER IDENTIFICATION NUMBER