MEDICARE: LINCOURT PHARMACY CORP

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	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881151603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOURT PHARMACY CORP

Provider Business Mailing Address
First Line	:	PO BOX 17175
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33682-7175
Country	:	US
Telephone Number	:	727-479-3048
Fax Number	:	727-479-3047

Provider Business Practice Location Address
First Line	:	501 S LINCOLN AVE STE 10
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5901
Country	:	US
Telephone Number	:	727-479-3048
Fax Number	:	727-479-3047

Authorized Official
Title or Position	:	CFO
Name	:	STEPHEN O BANJOKO
Credential	:
Telephone Number	:	813-341-4000

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	01/21/2026

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Directions to “LINCOURT PHARMACY CORP ” Practice Location

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