Provider Demographics
NPI:1073813309
Name:CUMBERLAND PHARMACY LLC
Entity Type:Organization
Organization Name:CUMBERLAND PHARMACY LLC
Other - Org Name:AXCESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER/AUTHORIZED OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSANEME
Authorized Official - Middle Name:CHUKA
Authorized Official - Last Name:OKARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-273-1344
Mailing Address - Street 1:1047 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7703
Mailing Address - Country:US
Mailing Address - Phone:813-991-7233
Mailing Address - Fax:888-556-8496
Practice Address - Street 1:1047 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7703
Practice Address - Country:US
Practice Address - Phone:813-991-7233
Practice Address - Fax:813-991-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH247803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010831300Medicaid
2127461OtherPK