Healthcare Provider Details

I. General information

NPI: 1316958952
Provider Name (Legal Business Name): EXP PHARMACY SVC OF FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 BRYAN DAIRY RD
LARGO FL
33777-1324
US

IV. Provider business mailing address

8275 BRYAN DAIRY RD
LARGO FL
33777-1324
US

V. Phone/Fax

Practice location:
  • Phone: 800-589-7255
  • Fax: 727-395-7892
Mailing address:
  • Phone: 800-589-7255
  • Fax: 727-395-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH20840
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL MEDURE
Title or Position: GM
Credential: RPH
Phone: 800-589-7255