Organization
HEPZIBAH INC
Active
Other names
SRX Pharmacy #002
Organization subpart
No
Provider details
NPI number
Authorized official
JACK DIAMOND (OWNER, VP, AO)
(813) 484-8611
Entity
Organization
Contact information
Practice address
10802 MAIN ST, STE A, THONOTOSASSA, FL 33592-2840
(813) 413-8242
(813) 413-8302
Mailing address
3500 E FLETCHER AVE, TAMPA, FL 33613-4708
(813) 413-8242
(813) 413-8302
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH23546
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001349300
—
FL
01
—
2117414
PK
—
Enumeration date
10/14/2008
Last updated
07/19/2018
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