Healthcare Provider Details

I. General information

NPI: 1538472261
Provider Name (Legal Business Name): REPUBLIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S PARSONS AVE SUITE B
BRANDON FL
33511-5225
US

IV. Provider business mailing address

106 S PARSONS AVE SUITE B
BRANDON FL
33511-5225
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-4802
  • Fax:
Mailing address:
  • Phone: 813-653-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24707
License Number StateFL

VIII. Authorized Official

Name: MR. SIMPLICE ESSOU
Title or Position: OWNER
Credential:
Phone: 813-379-8585