=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538579503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALUED CHOICE PHARMACY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2014
-----------------------------------------------------
Last Update Date | 04/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5537 SHELDON RD STE Y
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33615-3173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-881-0600
-----------------------------------------------------
Fax | 813-881-0700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5537 SHELDON RD STE Y
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33615-3173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-881-0600
-----------------------------------------------------
Fax | 813-881-0700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MYHANH TRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-881-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH27275
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------