Healthcare Provider Details

I. General information

NPI: 1174684757
Provider Name (Legal Business Name): HEPZIBAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FLETCHER AVE STE 120
TAMPA FL
33613-4789
US

IV. Provider business mailing address

3500 E FLETCHER AVE STE 120
TAMPA FL
33613-4789
US

V. Phone/Fax

Practice location:
  • Phone: 813-632-9032
  • Fax: 813-632-9035
Mailing address:
  • Phone: 813-632-9032
  • Fax: 813-632-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19717
License Number StateFL

VIII. Authorized Official

Name: MR. OLUKAYODE THEOPHILUS OGUNDIPE
Title or Position: PHARMACIST
Credential:
Phone: 813-632-9032