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General NPI Number Information
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NPI Number | 1548558463
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Entity Type | Organization
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Legal Business Name | CBA PHARMACY INC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 13801 BRUCE B DOWNS BLVD STE 103&102
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City | TAMPA
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State | FL
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Zip | 33613-3946
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Country | US
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Telephone | 813-933-5830
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Fax | 813-933-5841
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Provider Business Mailing Address
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Address Line | 1911 W DR MARTIN LUTHER KING JR BLVD SUITE 1
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City | TAMPA
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State | FL
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Zip | 33607-6509
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Country | US
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Telephone | 813-933-5830
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Fax | 813-933-5841
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | CHIRANJEEVI JANNU
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Credential |
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Telephone | 813-933-5830
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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 | PH25680
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License Number State | FL
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