Healthcare Provider Details

I. General information

NPI: 1992035182
Provider Name (Legal Business Name): MEDROCK PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12540 RACE TRACK RD # D2
TAMPA FL
33626-3106
US

IV. Provider business mailing address

12540 RACE TRACK RD # D2
TAMPA FL
33626-3106
US

V. Phone/Fax

Practice location:
  • Phone: 727-240-1341
  • Fax: 727-240-1343
Mailing address:
  • Phone: 727-240-1341
  • Fax: 727-240-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24402
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AHMED ASHRAF AHMED
Title or Position: OWNER
Credential:
Phone: 727-240-1341