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General NPI Number Information
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NPI Number | 1336475482
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Entity Type | Organization
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Legal Business Name | MEDLINE ENTERPRISES INC
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 1206 PASADENA AVE S
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-6202
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Country | US
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Telephone | 727-344-5151
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Fax | 727-489-9489
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Provider Business Mailing Address
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Address Line | PO BOX 55632
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City | ST PETERSBURG
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State | FL
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Zip | 33732-5632
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Country | US
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Telephone | 813-494-0458
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Fax | 727-489-9489
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Authorized Official
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Title or Position | PRESIDENT
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Name | KING YEOTAN
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Credential |
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Telephone | 727-344-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH24282
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License Number State | FL
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