Healthcare Provider Details

I. General information

NPI: 1134488661
Provider Name (Legal Business Name): LAMBRIGHT PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 W WATERS AVE STE 2
TAMPA FL
33614-1972
US

IV. Provider business mailing address

4202 W WATERS AVE STE #2
TAMPA FL
33614-1972
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-7971
  • Fax: 813-872-0697
Mailing address:
  • Phone: 813-877-7971
  • Fax: 813-872-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23197
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REJI ALEX
Title or Position: RPH/ PIC
Credential:
Phone: 813-877-7971