=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346486545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TVPHARMACIST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2008
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9011 PARK BLVD STE 206
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33777-4123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-1492
-----------------------------------------------------
Fax | 727-342-5850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9011 PARK BLVD STE 206
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33777-4123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-1492
-----------------------------------------------------
Fax | 727-342-5850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MANAGING MBR
-----------------------------------------------------
Name | ALPESH PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-398-1492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH23766
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------