Healthcare Provider Details

I. General information

NPI: 1477573780
Provider Name (Legal Business Name): K T PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E SUMMERLIN ST
BARTOW FL
33830-4731
US

IV. Provider business mailing address

490 E SUMMERLIN ST
BARTOW FL
33830-4731
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-4102
  • Fax: 863-533-0824
Mailing address:
  • Phone: 863-533-4102
  • Fax: 863-533-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19
License Number StateFL

VIII. Authorized Official

Name: MS. GWEN CORTNEY PARKER
Title or Position: LEAD PHARMACY TECH ASST MANAGER
Credential: CPHT
Phone: 863-533-4102