NPIMap

Organization Active NPI

Park Shore Drug Inc

  • Durable Medical Equipment & Medical Supplies
  • Miami Shores, FL
National Provider Identifier
1063595932
Registry record updated Jul 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
PH0000863 Issued in FL
Legal business name
PARK SHORE DRUG INC
Practice address
9531 NE 2ND Ave
Miami Shores, FL 33138-2704
Phone
(305) 754-9508
Fax
(305) 754-3512
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert D Gillis, R.PH.
Title
V.P.
Phone
(305) 754-9508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PH0000863 FL Primary

Addresses

Primary practice location

9531 NE 2ND Ave
Miami Shores, FL 33138-2704

Mailing address

9531 NE 2ND Ave
Miami Shores, FL 33138-2704
Phone (305) 754-9508

Other identifiers 1

IdentifierTypeStateIssuer
671982104MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Park Shore Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1063595932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9531 NE 2ND AVE",
            "city": "MIAMI SHORES",
            "state": "FL",
            "postal_code": "331382704",
            "telephone_number": "305-754-9508",
            "fax_number": "305-754-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9531 NE 2ND AVE",
            "city": "MIAMI SHORES",
            "state": "FL",
            "postal_code": "331382704",
            "telephone_number": "305-754-9508",
            "fax_number": "305-754-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK SHORE DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "GILLIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "V.P.",
        "authorized_official_telephone_number": "305-754-9508",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "PH0000863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "671982104",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Shores, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.