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General NPI Number Information
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NPI Number | 1467520262
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Entity Type | Organization
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Legal Business Name | KENNETH D. WURSTER DRUGS, INC.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 3206 S WEST SHORE BLVD
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City | TAMPA
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State | FL
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Zip | 33629-7652
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Country | US
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Telephone | 813-837-9095
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Fax | 813-839-0802
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Provider Business Mailing Address
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Address Line | 3206 S WEST SHORE BLVD
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City | TAMPA
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State | FL
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Zip | 33629-7652
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Country | US
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Telephone | 813-837-9095
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Fax | 813-839-0802
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Authorized Official
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Title or Position | PRES
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Name | MAYRA WURSTER
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Credential | PHARM D
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Telephone | 813-837-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | PH10939
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License Number State | FL
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