Healthcare Provider Details

I. General information

NPI: 1942652110
Provider Name (Legal Business Name): OXFORD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12134 US HIGHWAY 19
HUDSON FL
34667-2058
US

IV. Provider business mailing address

20205 AUTUMN FERN AVE
TAMPA FL
33647-2915
US

V. Phone/Fax

Practice location:
  • Phone: 727-378-4615
  • Fax: 727-378-4915
Mailing address:
  • Phone: 561-371-6174
  • Fax: 727-378-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30166
License Number StateFL

VIII. Authorized Official

Name: DAHDRIAN ADEWUMI
Title or Position: PHARMACY OWNER
Credential:
Phone: 561-371-6174