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General NPI Number Information
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NPI Number | 1053729418
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Entity Type | Organization
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Legal Business Name | NIMOH PHARMACY AND COMPOUNDING LLC
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 12878 US HIGHWAY 301
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City | DADE CITY
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State | FL
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Zip | 33525-5801
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Country | US
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Telephone | 352-437-5985
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Fax | 352-437-5986
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Provider Business Mailing Address
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Address Line | 12878 US HIGHWAY 301
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City | DADE CITY
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State | FL
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Zip | 33525-5801
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Country | US
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Telephone | 352-437-5985
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Fax |
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Authorized Official
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Title or Position | P.I.C / OWNER
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Name | DADDY NIMOH BOATENG
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Credential | RPH
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Telephone | 352-437-5985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28347
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License Number State | FL
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