NPIMap

Organization Active NPI

Park Shore Drug Inc

  • Durable Medical Equipment & Medical Supplies
  • Hallandale Beach, FL
National Provider Identifier
1285724492
Registry record updated Jun 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
PH13376 Issued in FL
Legal business name
PARK SHORE DRUG INC
Practice address
600 Ansin Blvd
Hallandale Beach, FL 33009-2118
Phone
(954) 874-4646
Fax
(954) 455-3718
NPI assigned
Oct 16, 2006
Last updated
Jun 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2012

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.NPI 1861680811
Title
President
Phone
(954) 349-0369

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PH13376 FL Primary

Addresses

Primary practice location

600 Ansin Blvd
Hallandale Beach, FL 33009-2118

Mailing address

600 Ansin Blvd
Hallandale Beach, FL 33009-2118
Phone (954) 874-4646

Other identifiers 1

IdentifierTypeStateIssuer
671982196MedicaidFL

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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1285724492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 ANSIN BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330092118",
            "telephone_number": "954-874-4646",
            "fax_number": "954-455-3718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ANSIN BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330092118",
            "telephone_number": "954-874-4646",
            "fax_number": "954-455-3718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK SHORE DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "GILLIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-349-0369",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "PH13376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "671982196",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hallandale Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; 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.