Provider Demographics
NPI:1144407636
Name:FELKY RX LLC
Entity Type:Organization
Organization Name:FELKY RX LLC
Other - Org Name:FELKY RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKOWULU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:813-508-2090
Mailing Address - Street 1:PO BOX 17507
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-7507
Mailing Address - Country:US
Mailing Address - Phone:813-264-0777
Mailing Address - Fax:813-264-0329
Practice Address - Street 1:14510 N FLORDIA AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-264-0777
Practice Address - Fax:813-264-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH231473336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032010OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL032496500Medicaid
6293700002Medicare NSC