=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750772612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX FLORIDA PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2015
-----------------------------------------------------
Last Update Date | 06/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3615 COLUMBIA STREET
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-704-6422
-----------------------------------------------------
Fax | 407-704-6322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 HERRINGBONE WAY ORMOND BEACH. FL 32174
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-559-6734
-----------------------------------------------------
Fax | 407-704-6322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | TOPE KASSIM MABIFA
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 407-704-6422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH28826
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH28826
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------