Organization
CAPRICORN HEALTHCARE SERVICES LLC
Active
Other names
HILLSBORO SPECIALTY PHARMACY, BLOOD PRESSURE AND DIABETIC CE
Organization subpart
No
Provider details
NPI number
Authorized official
ADENIKE NIKI GANSALLO BSC PHARMACY (PRESIDENT)
(813) 628-8400
Entity
Organization
Contact information
Practice address
4505 E HILLSBOROUGH AVE STE D&E, SUITE D & E, TAMPA, FL 33610-5200
(813) 628-8400
(813) 628-8484
Mailing address
4505 E HILLSBOROUGH AVE STE D&E, SUITE D & E, TAMPA, FL 33610-5200
(813) 628-8400
(813) 628-8484
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24697
FL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002675800
—
FL
01
—
2125531
PK
—
Enumeration date
06/21/2010
Last updated
04/17/2017
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