Provider Demographics
NPI:1487800264
Name:PINELLAS COMPOUNDING PHARMACY INC
Entity type:Organization
Organization Name:PINELLAS COMPOUNDING PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOI-LING
Authorized Official - Middle Name:
Authorized Official - Last Name:SAH
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:727-239-0300
Mailing Address - Street 1:1611 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4759
Mailing Address - Country:US
Mailing Address - Phone:727-239-0300
Mailing Address - Fax:888-888-8736
Practice Address - Street 1:1609-1611 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-239-0300
Practice Address - Fax:888-888-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH212423336C0004X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004360OtherPK