Healthcare Provider Details

I. General information

NPI: 1164800298
Provider Name (Legal Business Name): TECA MEDICAL ENTERPRISES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26316 WESLEY CHAPEL BLVD
LUTZ FL
33559-7208
US

IV. Provider business mailing address

26316 WESLEY CHAPEL BLVD
LUTZ FL
33559-7208
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-8100
  • Fax: 813-994-8104
Mailing address:
  • Phone: 813-994-8100
  • Fax: 813-994-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25912
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELLRIE ALLEN
Title or Position: OWNER
Credential:
Phone: 813-909-0100