Provider Demographics
NPI:1952611329
Name:SHUBHOM HEALTHCARE LLC
Entity Type:Organization
Organization Name:SHUBHOM HEALTHCARE LLC
Other - Org Name:SUN DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BHUMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-773-4460
Mailing Address - Street 1:3600 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6407
Mailing Address - Country:US
Mailing Address - Phone:941-556-9622
Mailing Address - Fax:941-556-9623
Practice Address - Street 1:3600 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6407
Practice Address - Country:US
Practice Address - Phone:941-556-9622
Practice Address - Fax:941-556-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH249963336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003014800Medicaid
2127229OtherPK
5702166OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL003014801OtherFL. MEDICAID DME