Healthcare Provider Details

I. General information

NPI: 1982341277
Provider Name (Legal Business Name): MANGO RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11509 E. MLK JR BLVD
MANGO FL
33550
US

IV. Provider business mailing address

2812 W DR. MARTIN LUTHER KING JR. BLVD
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-2263
  • Fax: 813-662-2263
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HARDIKKUMAR PATEL
Title or Position: OWNER
Credential:
Phone: 973-362-6086