MEDICARE: VENAN EBIMOBOWEI NANAKUMO MPHARM

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	1835P1200X	Pharmacotherapy Pharmacist	PH32364	FL

General Provider Information

NPI Number	:	1174823611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENAN EBIMOBOWEI NANAKUMO MPHARM

Provider Business Mailing Address
First Line	:	1412 W WATERS AVE
Second Line	:	SUITE 103
City	:	TAMPA
State	:	FL
Zip	:	33604-2802
Country	:	US
Telephone Number	:	813-931-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 W WATERS AVE
Second Line	:	SUITE 103
City	:	TAMPA
State	:	FL
Zip	:	33604-2802
Country	:	US
Telephone Number	:	813-931-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	11/01/2010

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