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General NPI Number Information
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NPI Number | 1578715215
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Entity Type | Organization
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Legal Business Name | HEPZIBAH INC
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 10802 MAIN ST STE A
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City | THONOTOSASSA
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State | FL
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Zip | 33592-2840
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Country | US
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Telephone | 813-413-8242
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Fax | 813-413-8302
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Provider Business Mailing Address
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Address Line | 3500 E FLETCHER AVE
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City | TAMPA
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State | FL
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Zip | 33613-4708
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Country | US
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Telephone | 813-413-8242
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Fax | 813-413-8302
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Authorized Official
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Title or Position | OWNER, VP, AO
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Name | JACK DIAMOND
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Credential |
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Telephone | 813-484-8611
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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 | PH23546
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License Number State | FL
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