Healthcare Provider Details

I. General information

NPI: 1245275452
Provider Name (Legal Business Name): MEDIPHARM RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 N CLARK AVE
TAMPA FL
33614-7038
US

IV. Provider business mailing address

4607 N CLARK AVE
TAMPA FL
33614-7038
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-0881
  • Fax: 813-876-0883
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN HAWES
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 813-876-0881