Provider Demographics
NPI:1487883856
Name:STOBIDEK, INC
Entity type:Organization
Organization Name:STOBIDEK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-793-2679
Mailing Address - Street 1:1333 W C 48 STE A
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-8923
Mailing Address - Country:US
Mailing Address - Phone:352-793-2679
Mailing Address - Fax:352-793-3125
Practice Address - Street 1:1333 W C 48 STE A
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-8923
Practice Address - Country:US
Practice Address - Phone:352-793-2679
Practice Address - Fax:352-793-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH241493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120956OtherPK
FL019905200Medicaid
FL001323101Medicaid