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General NPI Number Information
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NPI Number | 1467653915
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Entity Type | Organization
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Legal Business Name | SUPERIOR PHARMACY LLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 3031 W CYPRESS ST SUITE B
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City | TAMPA
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State | FL
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Zip | 33609-1647
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Country | US
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Telephone | 813-874-2848
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Fax | 813-874-0709
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Provider Business Mailing Address
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Address Line | 3031 W CYPRESS ST SUITE B
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City | TAMPA
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State | FL
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Zip | 33609-1647
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Country | US
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Telephone | 813-874-2848
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Fax | 813-874-0709
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Authorized Official
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Title or Position | OWNER
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Name | IKE OKEKE
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Credential | RPH
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Telephone | 813-874-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH21333
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License Number State | FL
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