Healthcare Provider Details

I. General information

NPI: 1922644491
Provider Name (Legal Business Name): MY PRESCRIPTION COACH COM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E 93RD AVE
TAMPA FL
33612-8636
US

IV. Provider business mailing address

2111 E 93RD AVE
TAMPA FL
33612-8636
US

V. Phone/Fax

Practice location:
  • Phone: 813-867-8213
  • Fax: 813-443-1398
Mailing address:
  • Phone: 813-867-8213
  • Fax: 813-443-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SHELLEY HIGHTOWER
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 813-867-8213