Healthcare Provider Details

I. General information

NPI: 1619534997
Provider Name (Legal Business Name): ULTIMATE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MARINER BLVD
SPRING HILL FL
34609-5657
US

IV. Provider business mailing address

1250 MARINER BLVD
SPRING HILL FL
34609-5657
US

V. Phone/Fax

Practice location:
  • Phone: 352-592-6340
  • Fax: 352-592-6345
Mailing address:
  • Phone: 352-592-6340
  • Fax: 352-592-6345

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: MR. ABLY TEKLE
Title or Position: MANAGER
Credential: PHARMD.
Phone: 352-592-6340