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General NPI Number Information
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NPI Number | 1063642197
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Entity Type | Organization
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Legal Business Name | HARRIETH N ALADIUME
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 2039 E EDGEWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33803-3601
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Country | US
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Telephone | 863-937-1050
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Fax | 863-937-1055
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Provider Business Mailing Address
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Address Line | 2039 E EDGEWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33803-3601
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Country | US
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Telephone | 863-937-1050
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Fax | 863-937-1055
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Authorized Official
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Title or Position | PHARMACIST/MANAGER
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Name | ABIY TEKLE
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Credential | PHARMD
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Telephone | 339-224-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24008
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License Number State | FL
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