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General NPI Number Information
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NPI Number | 1619335601
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Entity Type | Organization
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Legal Business Name | RIDGELAND ALLIED PHARMACY, INC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 804 W BLOOMINGDALE AVE STE. 1-4
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City | BRANDON
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State | FL
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Zip | 33511-7778
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Country | US
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Telephone | 813-689-9489
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Fax | 813-689-9682
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Provider Business Mailing Address
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Address Line | 804 W BLOOMINGDALE AVE STE. 1-4
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City | BRANDON
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State | FL
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Zip | 33511-7778
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Country | US
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Telephone | 813-689-9489
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Fax | 813-689-9682
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. DERYCK KARL JOSEPHS
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Credential | RPH
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Telephone | 813-689-9489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH 27215
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License Number State | FL
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