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General NPI Number Information
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NPI Number | 1245658236
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Entity Type | Organization
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Legal Business Name | ST. VERENA LLC.
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 13910 FIVAY RD SUITE 3
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 813-920-7063
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Fax |
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Provider Business Mailing Address
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Address Line | 3633 BENERAID ST
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City | LAND O LAKES
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State | FL
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Zip | 34638-7919
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Country | US
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Telephone | 813-464-0563
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | BAHER RIZKALLA
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Credential |
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Telephone | 813-464-0563
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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 | PH27506
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License Number State | FL
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