=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457934929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME CARE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2021
-----------------------------------------------------
Last Update Date | 05/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2176 MARINER BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-600-8083
-----------------------------------------------------
Fax | 352-600-7033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2176 MARINER BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-684-8477
-----------------------------------------------------
Fax | 352-684-6877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENT
-----------------------------------------------------
Name | VENKATESHWARLU THAUDBOINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-600-8083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------