Organization
LISSMART MEDICAL SUPPLIES INC
Active
Other names
LISSMART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LISVET MARTINEZ (PRESIDENT)
(813) 374-2452
Entity
Organization
Contact information
Practice address
4579 GUNN HWY, TAMPA, FL 33624-6311
(813) 374-2452
(813) 374-2453
Mailing address
4579 GUNN HWY, TAMPA, FL 33624-6311
(813) 374-2452
(813) 374-2453
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH24199
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032313600
—
FL
01
—
1053076
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/08/2009
Last updated
05/17/2013
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