Organization
DAVITA MEDICAL FLORIDA, INC.
Active
Other names
DaVita Medical Group, Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HILGER (CHIEF ACCOUNTING OFFICER)
(253) 973-0777
Entity
Organization
Contact information
Practice address
1931 W LUMSDEN RD, BRANDON, FL 33511-8819
(813) 681-7888
(813) 661-0843
Mailing address
10051 5TH STREET NORTH, ST. PETERSBURG, FL 33702-2299
(813) 681-7888
(813) 661-0843
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH13061
FL
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030848000
—
FL
01
—
2013026
PK
—
05
—
4399230004
—
FL
Enumeration date
12/11/2006
Last updated
05/10/2017
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