| Organization Name: | SOUTHSHORE PHARMACY, INC. |
| NPI Number: | 1710381694 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID A FLAX (OWNER) |
| Mailing Address: | 13127 Kings Lake Dr. Unit 102 Gibsonton |
| State: | FL US |
| Postal Code: | 335343958 |
| Phone Number: | 8136729600 |
| Fax Number: | 8136131968 |
| NPI Enumeration Date: | 10/21/2014 |
| NPI Last Update Date: | 09/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |