Healthcare Provider Details

I. General information

NPI: 1740587120
Provider Name (Legal Business Name): MEDILOT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 05/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 MARINER BLVD
SPRING HILL FL
34609-2469
US

IV. Provider business mailing address

4127 MARINER BLVD
SPRING HILL FL
34609-2469
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-7937
  • Fax: 352-835-7938
Mailing address:
  • Phone: 352-835-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25268
License Number StateFL

VIII. Authorized Official

Name: MR. FEMI O OLATUNJI
Title or Position: PHARMACY MANGER
Credential:
Phone: 813-500-7980