Healthcare Provider Details

I. General information

NPI: 1740306893
Provider Name (Legal Business Name): WIN-DIXIE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11926 GROVEWOOD AVE
THONOTOSASSA FL
33592-2848
US

IV. Provider business mailing address

11926 GROVEWOOD AVE
THONOTOSASSA FL
33592-2848
US

V. Phone/Fax

Practice location:
  • Phone: 813-986-0788
  • Fax: 813-986-9607
Mailing address:
  • Phone: 813-986-0788
  • Fax: 813-986-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number380100106110506
License Number StateFL

VIII. Authorized Official

Name: VICTOR OSEI-KOFI
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 813-986-0788