Organization
MEDICAL HOME ALLIANCE LLC
Active
Other names
IMA West Tampa Dispensary
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA D PEREZ (COO)
(407) 845-0330
Entity
Organization
Contact information
Practice address
4700 N HABANA AVE, TAMPA, FL 33614-7160
(813) 444-9599
(813) 513-8210
Mailing address
6675 WESTWOOD BLVD STE 475, ORLANDO, FL 32821-6027
(407) 845-0330
(888) 972-1752
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ACN515
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018418600
—
FL
Enumeration date
11/20/2017
Last updated
11/20/2017
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