1134437650 NPI number — VALUE RX ZEPHYRHILLS LLC

Table of content: (NPI 1134437650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134437650 NPI number — VALUE RX ZEPHYRHILLS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALUE RX ZEPHYRHILLS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134437650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 W HENRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-5542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-712-5223
Provider Business Mailing Address Fax Number:
813-712-5237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38160 MEDICAL CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33540-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-788-5000
Provider Business Practice Location Address Fax Number:
813-788-5005
Provider Enumeration Date:
09/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
CHETAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
813-712-5200

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH24849 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5701722 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".