Organization
MEDLINE ENTERPRISES INC
Active
Other names
promed pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KING YEOTAN (D)
(813) 494-0458
Entity
Organization
Contact information
Practice address
3336 S DALE MABRY HWY, TAMPA, FL 33629-7840
(813) 832-5151
(727) 489-9489
Mailing address
3336 S DALE MABRY HWY, TAMPA, FL 33629-7840
(813) 832-5151
(727) 489-9489
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH23943
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1045702
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/29/2009
Last updated
12/03/2010
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