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General NPI Number Information
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NPI Number | 1114579158
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Entity Type | Organization
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Legal Business Name | DOCTORS DIET PROGRAM OF SOUTH FLORIDA PLLC
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 1501 W REYNOLDS ST
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City | PLANT CITY
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State | FL
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Zip | 33563-4707
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Country | US
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Telephone | 813-519-3438
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Fax | 813-280-2258
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Provider Business Mailing Address
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Address Line | 3345 S DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33629-7817
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Country | US
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Telephone | 813-839-3438
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Fax | 813-280-2258
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Authorized Official
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Title or Position | DIR OF CLINIC OPERATIONS
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Name | JAMES LOWRANCE
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Credential |
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Telephone | 813-957-6281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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