Organization
COMMUNITY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCE PAYNE (CFO)
(941) 552-1189
Entity
Organization
Contact information
Practice address
4221 N HIMES AVE, TAMPA, FL 33607-6229
(813) 769-0879
Mailing address
4054 SAWYER RD, SARASOTA, FL 34233-1272
(941) 552-1189
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
01/05/2023
Last updated
01/05/2023
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