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NPI Code Detail

MEDICARE: MY PHARMACY OF TAMPA LLC

MEDICARE: MY PHARMACY OF TAMPA LLC
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
1333600000XPharmacy
23336S0011XSpecialty Pharmacy
33336C0003XCommunity/Retail PharmacyPH25203FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12128620OTHERPK

General Provider Information

NPI Number : 1457656373
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY PHARMACY OF TAMPA LLC
Provider Business Mailing Address
First Line : 5002 TARI STREAM WAY
Second Line :
City : BRANDON
State : FL
Zip : 33511-8416
Country : US
Telephone Number : 813-689-7580
Fax Number :
Provider Business Practice Location Address
First Line : 7108 CAUSEWAY BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33619-6364
Country : US
Telephone Number : 813-628-4441
Fax Number : 813-628-4442
Authorized Official
Title or Position : PHARMACY MANAGER
Name : TIN NGUYEN
Credential :
Telephone Number : 727-692-7584
Provider Enumeration Date : 01/24/2011
Last Update Date : 03/31/2015

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Directions to “MY PHARMACY OF TAMPA LLC ” Practice Location

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