Healthcare Provider Details

I. General information

NPI: 1427739895
Provider Name (Legal Business Name): MMRX HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11661 COUNTRYWAY BLVD
TAMPA FL
33626-2739
US

IV. Provider business mailing address

11661 COUNTRYWAY BLVD
TAMPA FL
33626-2739
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-7158
  • Fax: 813-279-6264
Mailing address:
  • Phone: 813-264-7158
  • Fax: 813-279-6264

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 Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CLAY MOBLEY
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 386-208-8757