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General NPI Number Information
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NPI Number | 1295338366
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Entity Type | Individual
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Provider Name | VIRGIL LEE EALY RPH
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Gender | Male
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 2021 W BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-4701
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Country | US
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Telephone | 813-657-5441
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 E POWHATAN AVE
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City | TAMPA
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State | FL
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Zip | 33604-7231
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Country | US
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Telephone | 813-784-3536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PS27859
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License Number State | FL
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