Organization
AGNES RX INC
Active
Other names
Macdill Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AGNES PARK (PRESIDENT/PHARMACIST)
(813) 870-6300
Entity
Organization
Contact information
Practice address
2800 N MACDILL AVE, STE C, TAMPA, FL 33607-2208
(813) 870-6300
(813) 870-6904
Mailing address
2800 N MACDILL AVE, STE C, TAMPA, FL 33607-2208
(813) 870-6300
(813) 870-6904
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH26103
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005987000
—
FL
01
—
1042768
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/02/2009
Last updated
02/14/2013
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