Provider Demographics
NPI:1679561591
Name:GULFSTREAM PHARMACY, INC.
Entity type:Organization
Organization Name:GULFSTREAM PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-276-4800
Mailing Address - Street 1:4998 N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7364
Mailing Address - Country:US
Mailing Address - Phone:561-276-4800
Mailing Address - Fax:561-276-5990
Practice Address - Street 1:4998 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7364
Practice Address - Country:US
Practice Address - Phone:561-276-4800
Practice Address - Fax:561-276-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0160080001Medicare ID - Type Unspecified