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General NPI Number Information
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NPI Number | 1457530040
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Entity Type | Organization
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Legal Business Name | ORANGE-BAY PHARMACY LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 4625 N NEBRASKA AVE
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City | TAMPA
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State | FL
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Zip | 33603-4013
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Country | US
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Telephone | 813-418-6780
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Fax | 813-238-0237
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Provider Business Mailing Address
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Address Line | 4625 N NEBRASKA AVE
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City | TAMPA
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State | FL
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Zip | 33603-4013
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Country | US
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Telephone | 813-418-6780
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Fax | 813-238-0237
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Authorized Official
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Title or Position | CO OWNER
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Name | LANRE OKUSANYA
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Credential | PHRMD
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Telephone | 412-996-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH23400
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License Number State | FL
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