MEDICARE: CIRQUE DU RX 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH23940	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2120160	OTHER		PK

General Provider Information

NPI Number	:	1376784926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRQUE DU RX CORP

Provider Business Mailing Address
First Line	:	7758 PALM RIVER RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4215
Country	:	US
Telephone Number	:	813-971-5551
Fax Number	:	813-979-1888

Provider Business Practice Location Address
First Line	:	7758 PALM RIVER RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4215
Country	:	US
Telephone Number	:	813-971-5551
Fax Number	:	813-979-1888

Authorized Official
Title or Position	:	OWNER, PIC, AO
Name	:	ADOLPHUS AKANIRU
Credential	:	RPH
Telephone Number	:	813-971-5551

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	09/30/2019

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Directions to “CIRQUE DU RX CORP ” Practice Location

Language	Start Address	Practice Location

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