Organization
VIRGIN MARYS PHARMACY CORP
Active
Other names
True vine pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMONYOUS ABDELMALAK (PHARMACY MANAGER)
(813) 252-7799
Entity
Organization
Contact information
Practice address
14606 N DALE MABRY, TAMPA, FL 33618
(813) 505-6684
Mailing address
25710 FRITH ST, LAND O LAKES, FL 34639-5682
(813) 505-6684
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
03/05/2020
Last updated
09/20/2021
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