MEDICARE: LINCOURT PHARMACY CORP

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH8725	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2003908	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134234164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOURT PHARMACY CORP

Provider Business Mailing Address
First Line	:	PO BOX 17175
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33682-7175
Country	:	US
Telephone Number	:	727-447-4248
Fax Number	:	727-445-9604

Provider Business Practice Location Address
First Line	:	501 S LINCOLN AVE
Second Line	:	STE 10
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5945
Country	:	US
Telephone Number	:	727-447-4248
Fax Number	:	727-445-9604

Authorized Official
Title or Position	:	CFO
Name	:	STEPHEN BANJOKO
Credential	:
Telephone Number	:	813-341-4000

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	01/21/2026

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Directions to “LINCOURT PHARMACY CORP ” Practice Location

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