Organization
MEDIPHARM-RX,INC.(SPECIAL CLOSED SYSTEM)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE L ELLIS RPH (PHARMACIST IN CHARGE)
(813) 876-0881
Entity
Organization
Contact information
Practice address
4607 N CLARK AVE, TAMPA, FL 33614-7038
(813) 876-0881
(813) 876-0883
Mailing address
4607 N CLARK AVE, TAMPA, FL 33614-7038
(813) 876-0881
(813) 876-0883
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PH21000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH21000
FLORIDA PHARMACY LICENSE
FL
Enumeration date
11/20/2006
Last updated
08/22/2020
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