Provider Demographics
NPI:1003060195
Name:GERIZIM VENTURES INC
Entity Type:Organization
Organization Name:GERIZIM VENTURES INC
Other - Org Name:AMEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-209-0619
Mailing Address - Street 1:521 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2116
Mailing Address - Country:US
Mailing Address - Phone:727-209-0619
Mailing Address - Fax:727-209-0625
Practice Address - Street 1:521 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2116
Practice Address - Country:US
Practice Address - Phone:727-209-0619
Practice Address - Fax:727-209-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
FLPH236813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117829OtherPK