Healthcare Provider Details

I. General information

NPI: 1114343084
Provider Name (Legal Business Name): PRAXIS SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 W WATERS AVE SUITE 214
TAMPA FL
33634-1260
US

IV. Provider business mailing address

5455 W WATERS AVE SUITE 214
TAMPA FL
33634-1260
US

V. Phone/Fax

Practice location:
  • Phone: 888-903-7453
  • Fax:
Mailing address:
  • Phone: 888-903-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH28049
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA CANNONE
Title or Position: PRESIDENT
Credential:
Phone: 813-867-7162