Healthcare Provider Details

I. General information

NPI: 1982956702
Provider Name (Legal Business Name): 5M PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6056 VAN DYKE RD
LUTZ FL
33558-8000
US

IV. Provider business mailing address

6056 VAN DYKE RD
LUTZ FL
33558-8000
US

V. Phone/Fax

Practice location:
  • Phone: 813-968-9100
  • Fax: 813-968-9200
Mailing address:
  • Phone: 813-968-9100
  • Fax: 813-968-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26522
License Number StateFL

VIII. Authorized Official

Name: VIRAL SHAH
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential:
Phone: 813-968-9100