=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366770976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXXYCOM INVESTMENT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2009
-----------------------------------------------------
Last Update Date | 02/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 COLLIER PKWY
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-8718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-406-4929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1825 COLLIER PKWY
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-8718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-406-4929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PARVINDER S KAINTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-271-1984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24351
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------