=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427470780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICASCRIPTS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2014
-----------------------------------------------------
Last Update Date | 07/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 N. FLORIDA AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-968-0520
-----------------------------------------------------
Fax | 813-968-0482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15511 N FLORIDA AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-1263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-968-0520
-----------------------------------------------------
Fax | 813-968-0482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | BHAVIK PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-968-0520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH27292
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------