Organization
DJ PHARMACY LLC
Active
Other names
DJ PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
OMOTADE IKUDAYISI (OWNER)
(813) 495-2234
Entity
Organization
Contact information
Practice address
5622 MARINE PKWY STE 23, NEW PORT RICHEY, FL 34652-4335
(727) 232-0646
Mailing address
20122 SHADY HILL LN, TAMPA, FL 33647-3396
(813) 495-2234
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH24393
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1052632
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/15/2010
Last updated
09/19/2011
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