=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831499557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUADREN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2010
-----------------------------------------------------
Last Update Date | 02/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 N DALE MABRY HWY BUILDING 801 SUITE #A
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-3290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-935-4936
-----------------------------------------------------
Fax | 813-935-4938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8001 N DALE MABRY HWY BUILDING 801 SUITE #A
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-3290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-935-4936
-----------------------------------------------------
Fax | 813-935-4938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAJUDEEN YUSUF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-480-9223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24258
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------