Healthcare Provider Details

I. General information

NPI: 1871999516
Provider Name (Legal Business Name): HM BRANDON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 PARSONS PARK DR
BRANDON FL
33511-6066
US

IV. Provider business mailing address

805 E BLOOMINGDALE AVE STE 302
BRANDON FL
33511-8113
US

V. Phone/Fax

Practice location:
  • Phone: 813-315-3774
  • Fax: 813-662-4792
Mailing address:
  • Phone: 813-689-2273
  • Fax: 813-662-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28695
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH28695
License Number StateFL

VIII. Authorized Official

Name: HARSHADKUMAR PATEL
Title or Position: OWNER
Credential:
Phone: 813-662-4791