Healthcare Provider Details

I. General information

NPI: 1811221385
Provider Name (Legal Business Name): GUDOC PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S PARSONS AVE
BRANDON FL
33511-5225
US

IV. Provider business mailing address

106 S PARSONS AVE
BRANDON FL
33511-5225
US

V. Phone/Fax

Practice location:
  • Phone: 813-381-3971
  • Fax: 813-381-3973
Mailing address:
  • Phone: 813-381-3971
  • Fax: 813-381-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24264
License Number StateFL

VIII. Authorized Official

Name: UGOCHUKWU J.O. CHIADI
Title or Position: MANAGER
Credential: RPH
Phone: 813-381-3971