MEDICARE: SUPERIOR PHARMACY LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	PH0020915	FL

General Provider Information

NPI Number	:	1962603431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR PHARMACY LLC

Provider Business Mailing Address
First Line	:	5101 E BUSCH BLVD STE 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5380
Country	:	US
Telephone Number	:	813-989-1351
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 E BUSCH BLVD STE 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5380
Country	:	US
Telephone Number	:	813-989-1351
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IKE OKEKE
Credential	:
Telephone Number	:	813-989-1351

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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