Organization
GERIZIM VENTURES INC
Active
Other names
Amen Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TAIWO OWOEYE (PRESIDENT)
(727) 209-0619
Entity
Organization
Contact information
Practice address
521 DR MARTIN LUTHER KING JR ST N, ST PETERSBURG, FL 33701-2116
(727) 209-0619
(727) 209-0625
Mailing address
521 DR MARTIN LUTHER KING JR ST N, ST PETERSBURG, FL 33701-2116
(727) 209-0619
(727) 209-0625
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH23681
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117829
PK
—
Enumeration date
11/17/2008
Last updated
11/01/2016
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