Provider Demographics
NPI:1669577656
Name:HEDGES PRESCRIPTION SHOP OF SARASOTA INC
Entity type:Organization
Organization Name:HEDGES PRESCRIPTION SHOP OF SARASOTA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MOTTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:941-366-2424
Mailing Address - Street 1:24 N LIME AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6120
Mailing Address - Country:US
Mailing Address - Phone:941-366-2424
Mailing Address - Fax:941-954-6043
Practice Address - Street 1:24 N LIME AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6120
Practice Address - Country:US
Practice Address - Phone:941-366-2424
Practice Address - Fax:941-954-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X
FLPH22632332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031907401Medicaid
FL031907400Medicaid
FL1020255OtherNABP NUMBER
FL031907401Medicaid