Provider Demographics
NPI:1750006656
Name:SEMINOLE PHARMACY
Entity type:Organization
Organization Name:SEMINOLE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANDHANA
Authorized Official - Middle Name:BHAGWAN
Authorized Official - Last Name:KISWANI-BARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-985-5151
Mailing Address - Street 1:6401 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4156
Mailing Address - Country:US
Mailing Address - Phone:954-965-1331
Mailing Address - Fax:
Practice Address - Street 1:850 SEMINOLE CROSSING TRL
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-4307
Practice Address - Country:US
Practice Address - Phone:239-867-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEMINOLE TRIBE OF FLORIDA HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy