Healthcare Provider Details

I. General information

NPI: 1366778532
Provider Name (Legal Business Name): HMVN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 US HIGHWAY 301 S SUITE 1
RIVERVIEW FL
33578-4387
US

IV. Provider business mailing address

7230 US HIGHWAY 301 S SUITE 1
RIVERVIEW FL
33578-4387
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-7466
  • Fax: 813-443-7468
Mailing address:
  • Phone: 813-443-7466
  • Fax: 813-443-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24312
License Number StateFL

VIII. Authorized Official

Name: KAMAL PATEL
Title or Position: RX MANAGER / PHARMACIST
Credential:
Phone: 813-443-4766