MEDICARE: NEIGHBOURHOOD PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH 24675	FL

General Provider Information

NPI Number	:	1043522782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBOURHOOD PHARMACY

Provider Business Mailing Address
First Line	:	1497 NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1497 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-2847
Country	:	US
Telephone Number	:	813-374-8955
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MRS. MOPELOLA DAUDU
Credential	:
Telephone Number	:	813-374-8955

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	07/10/2010

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