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General NPI Number Information
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NPI Number | 1184063455
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Entity Type | Organization
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Legal Business Name | XTRA CARE PHARMACY INC
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 6520 US HIGHWAY 301 S STE 106
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City | RIVERVIEW
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State | FL
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Zip | 33578-4324
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Country | US
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Telephone | 813-280-0927
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Fax | 813-677-4500
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Provider Business Mailing Address
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Address Line | 6520 US HIGHWAY 301 S SUITE 106
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City | RIVERVIEW
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State | FL
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Zip | 33578-4347
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Country | US
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Telephone | 813-280-0927
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Fax | 813-677-4500
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MILDRED PETERSIDE
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Credential |
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Telephone | 813-598-0593
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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 | PH26712
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License Number State | FL
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