Organization
ST. VERENA LLC.
Active
Other names
Medsource Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BAHER RIZKALLA (PHARMACIST/OWNER)
(813) 464-0563
Entity
Organization
Contact information
Practice address
13910 FIVAY RD, SUITE 3, HUDSON, FL 34667-7154
(813) 920-7063
Mailing address
3633 BENERAID ST, LAND O LAKES, FL 34638-7919
(813) 464-0563
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH27506
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145050
PK
—
Enumeration date
04/07/2014
Last updated
04/07/2014
About Stedi
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