MEDICARE: RESTORE PHARMA, 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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1699524124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE PHARMA, LLC

Provider Business Mailing Address
First Line	:	6507 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4021
Country	:	US
Telephone Number	:	813-111-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	12617 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1331
Country	:	US
Telephone Number	:	813-463-8009
Fax Number	:	813-463-8002

Authorized Official
Title or Position	:	OWNER / PIC
Name	:	DR. STEVE CADDICK
Credential	:	PHARMD
Telephone Number	:	813-111-1111

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	12/02/2025

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Directions to “RESTORE PHARMA, LLC ” Practice Location

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