Healthcare Provider Details

I. General information

NPI: 1073813309
Provider Name (Legal Business Name): CUMBERLAND PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 W BUSCH BLVD
TAMPA FL
33612-7703
US

IV. Provider business mailing address

1047 W BUSCH BLVD
TAMPA FL
33612-7703
US

V. Phone/Fax

Practice location:
  • Phone: 813-991-7233
  • Fax: 813-991-7255
Mailing address:
  • Phone: 813-991-7233
  • Fax: 888-556-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24780
License Number StateFL

VIII. Authorized Official

Name: DR. OSANEME CHUKA OKARO
Title or Position: PHARMACIST/OWNER/AUTHORIZED OFFICER
Credential: PHARMD
Phone: 850-273-1344