Provider Demographics
NPI:1831231737
Name:PRESCRIPTION SHOPPES III LLC
Entity type:Organization
Organization Name:PRESCRIPTION SHOPPES III LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:407-923-2223
Mailing Address - Street 1:203 HERRELL RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3635
Mailing Address - Country:US
Mailing Address - Phone:407-923-2223
Mailing Address - Fax:407-483-0265
Practice Address - Street 1:203 HERRELL RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-3635
Practice Address - Country:US
Practice Address - Phone:407-923-2223
Practice Address - Fax:407-483-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5507390001Medicare ID - Type Unspecified