Park Shore Drug Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

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

May 10, 2006

Organization subpart

No

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

Pharmacist, President

Phone

(954) 874-4646

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

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.

• Park Shore Drug Inc

  • Durable Medical Equipment & Medical Supplies
  • Miami Shores, FL
  • NPI 1063595932
  NPD tax ID
• Park Shore Drug Inc

  • Durable Medical Equipment & Medical Supplies
  • Hallandale Beach, FL
  • NPI 1285724492
  NPD tax ID
• Park Shore Drug Inc

  • Specialty Pharmacy
  • Miami Shores, FL
  • NPI 1386725356
  NPD tax ID
• Park Shore Drug Inc

  • Durable Medical Equipment & Medical Supplies
  • Hallandale Beach, FL
  • NPI 1417043100
  NPD tax ID

Locations

Networks

• HealthSun Health Plans Network
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512432000000",
    "number": "1982653523",
    "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": "2006-05-10",
        "last_updated": "2017-12-05",
        "status": "A",
        "authorized_official_last_name": "GILLIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHARMACIST, 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": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "FL",
            "license": "PH13376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018477700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LOCAL CARRIER #/PTAN",
            "identifier": "P1723B",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME, MEDICAID PHARMACY",
            "identifier": "018477701",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018614500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "1011915",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luis E Padron
• Palm Sands Podiatry PLLC
• Greta Pantani, LMT
• Park Shore Drug Inc
• Park Shore Drug Inc
• Jiwon Park, MD
• Adrian Paruas, D.M.D.
• Yuriy Pasisnichenko, MD
• Calin M Pastiu
• Irakly Pataraia, DPM

• Long Term Care Pharmacy in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• Long Term Care Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.