Provider Demographics
NPI:1144605023
Name:PHARMA-VILLE INC
Entity Type:Organization
Organization Name:PHARMA-VILLE INC
Other - Org Name:D/B/A: PHARMA-VILLE RX & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:813-605-0732
Mailing Address - Street 1:14857 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2027
Mailing Address - Country:US
Mailing Address - Phone:813-605-0732
Mailing Address - Fax:813-605-0733
Practice Address - Street 1:14857 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2027
Practice Address - Country:US
Practice Address - Phone:813-605-0732
Practice Address - Fax:813-605-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH292323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies