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General NPI Number Information
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NPI Number | 1184811994
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Entity Type | Organization
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Legal Business Name | FLORIDA DISCOUNT RX LLC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1951 W MLK JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607
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Country | US
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Telephone | 813-425-2195
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Fax | 813-382-1513
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Provider Business Mailing Address
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Address Line | 1951 W MLK JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHCY MANG
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Name | SUSAN TITA
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Credential | RPH
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Telephone | 813-335-0267
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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 |
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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 | PH22888
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License Number State | FL
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