MEDICARE: PHEMMY VENTURES INC

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
1	3336C0003X	Community/Retail Pharmacy	PH23188	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1036121	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487818340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHEMMY VENTURES INC

Provider Business Mailing Address
First Line	:	1412 W WATERS AVE
Second Line	:	STE 103
City	:	TAMPA
State	:	FL
Zip	:	33604-2802
Country	:	US
Telephone Number	:	813-931-3700
Fax Number	:	813-931-3747

Provider Business Practice Location Address
First Line	:	1412 W WATERS AVE STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2802
Country	:	US
Telephone Number	:	813-931-3700
Fax Number	:	813-931-3747

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	VENAN NANAKUMO
Credential	:	M.PHARM
Telephone Number	:	813-843-3224

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	10/14/2010

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Directions to “PHEMMY VENTURES INC ” Practice Location

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