NPIMap

Organization Active NPI

Park Shore Drug Inc

  • Durable Medical Equipment & Medical Supplies
  • Hallandale Beach, FL
National Provider Identifier
1417043100
Registry record updated Jun 21, 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) 455-1378
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 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.
Title
President.
Phone
(954) 874-4646

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
671982198MedicaidFL

Other names 1

  • Park Shore Pharmacon Doing business as

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1417043100",
    "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": "954-455-1378"
        },
        {
            "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": "954-455-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK SHORE DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2012-06-21",
        "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": "954-874-4646",
        "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": "671982198",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Shore Pharmacon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 21, 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.