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NPI Code Detail

MEDICARE: MR. MANOJ STEPHEN

MEDICARE: MR. MANOJ STEPHEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS42331FL

General Provider Information

NPI Number : 1144590829
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MANOJ STEPHEN
Provider Business Mailing Address
First Line : 1860 E FOWLER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-5511
Country : US
Telephone Number : 813-977-0651
Fax Number : 813-632-8030
Provider Business Practice Location Address
First Line : 1860 E FOWLER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-5511
Country : US
Telephone Number : 813-977-0651
Fax Number : 813-632-8030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2012
Last Update Date : 01/11/2012

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