Healthcare Provider Details

I. General information

NPI: 1740238666
Provider Name (Legal Business Name): TAMPA VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 BRUCE B DOWNS BLVD
TAMPA FL
33612-9211
US

IV. Provider business mailing address

PO BOX 94470
CLEVELAND OH
44101-4470
US

V. Phone/Fax

Practice location:
  • Phone: 813-903-4885
  • Fax: 819-910-4096
Mailing address:
  • Phone: 866-793-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579