Healthcare Provider Details

I. General information

NPI: 1629991534
Provider Name (Legal Business Name): ASHLEY ROSE BANTAD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 MCKINLEY DR
TAMPA FL
33612-6455
US

IV. Provider business mailing address

1115 E TWIGGS ST UNIT 1110
TAMPA FL
33602-3179
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-3488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS67164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: