Healthcare Provider Details

I. General information

NPI: 1073868444
Provider Name (Legal Business Name): HTB ENTERPRISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OAKLEY SEAVER DR SUITE #3
CLERMONT FL
34711
US

IV. Provider business mailing address

1500 OAKLEY SEAVER DR SUITE #3
CLERMONT FL
34711
US

V. Phone/Fax

Practice location:
  • Phone: 352-989-5850
  • Fax: 352-989-5849
Mailing address:
  • Phone: 352-989-5850
  • Fax: 352-989-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26241
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH26241
License Number StateFL

VIII. Authorized Official

Name: TUAN TRAN
Title or Position: OWNER
Credential: RPH
Phone: 407-903-1544