Southshore Pharmacy, Inc.

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

SOUTHSHORE PHARMACY, INC.

Practice address

13127 Kings Lake Dr.
Unit 102
Gibsonton, FL 33534-3958

Phone

(813) 672-9600

Fax

(813) 613-1968

NPI assigned

Oct 21, 2014

Last updated

Sep 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David A Flax

Title

Owner

Phone

(863) 712-3064

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441929600000",
    "number": "1710381694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13127 KINGS LAKE DR.",
            "address_2": "UNIT 102",
            "city": "GIBSONTON",
            "state": "FL",
            "postal_code": "335343958",
            "telephone_number": "813-672-9600",
            "fax_number": "813-613-1968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13127 KINGS LAKE DR.",
            "address_2": "UNIT 102",
            "city": "GIBSONTON",
            "state": "FL",
            "postal_code": "335343958",
            "telephone_number": "813-672-9600",
            "fax_number": "813-613-1968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSHORE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2015-09-11",
        "status": "A",
        "authorized_official_last_name": "FLAX",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-712-3064",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Roberts
• Jeteria Salter
• Leira Marie Santana, ARNP
• Genquetta Michelle Smith, INDEPENDE CONTRACTOR
• Southshore Orthodontics PA
• Lily Katherine Szwejbka, PT, DPT
• Marnelli Deborah Geronimo Tan
• Thai Pham DMD PA (Endodontic Innovations)
• Raquel Threatts
• Tykeila Ieshia Tisdale, CMHC, RMHC-I

• Compounding Pharmacy in Gibsonton, FL
• Providers in Gibsonton, FL by specialty
• Compounding Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2015; 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.