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General NPI Number Information
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NPI Number | 1609948488
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Entity Type | Organization
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Legal Business Name | SUPERIOR PHARMACY OF TEMPLE TERRACE LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 9780 N 56TH ST STE D
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-5508
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Country | US
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Telephone | 813-989-1351
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Fax | 813-988-4795
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Provider Business Mailing Address
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Address Line | 9780 N 56TH ST STE D
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-5508
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Country | US
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Telephone | 813-989-1351
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Fax | 813-988-4795
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Authorized Official
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Title or Position | OWNER
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Name | YVONNE OKEKE
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Credential |
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Telephone | 813-368-4873
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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 | PH20915
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License Number State | FL
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