Healthcare Provider Details

I. General information

NPI: 1366770976
Provider Name (Legal Business Name): MAXXYCOM INVESTMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 COLLIER PKWY
LUTZ FL
33549-8718
US

IV. Provider business mailing address

1825 COLLIER PKWY
LUTZ FL
33549-8718
US

V. Phone/Fax

Practice location:
  • Phone: 813-406-4929
  • Fax:
Mailing address:
  • Phone: 813-406-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24351
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PARVINDER S KAINTH
Title or Position: PRESIDENT
Credential:
Phone: 727-271-1984