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General NPI Number Information
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NPI Number | 1215335948
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Entity Type | Organization
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Legal Business Name | TAMPA ROAD PHARMACY
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 3705 TAMPA RD
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City | OLDSMAR
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State | FL
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Zip | 34677-6300
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Country | US
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Telephone | 347-816-2198
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Fax |
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Provider Business Mailing Address
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Address Line | 2488 JOHNNA CT
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City | PALM HARBOR
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State | FL
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Zip | 34685-2031
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Country | US
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Telephone | 347-816-2198
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Fax |
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Authorized Official
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Title or Position | REGISTERED PHARMACIST
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Name | MR. GEORGE SHENOUDA
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Credential | RPH
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Telephone | 347-816-2198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH28008
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License Number State | FL
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