Provider Demographics
NPI:1164800298
Name:TECA MEDICAL ENTERPRISES CORP
Entity Type:Organization
Organization Name:TECA MEDICAL ENTERPRISES CORP
Other - Org Name:T & C DISCOUNT PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-909-0100
Mailing Address - Street 1:26316 WESLEY CHAPEL BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7208
Mailing Address - Country:US
Mailing Address - Phone:813-994-8100
Mailing Address - Fax:813-994-8104
Practice Address - Street 1:26316 WESLEY CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7208
Practice Address - Country:US
Practice Address - Phone:813-994-8100
Practice Address - Fax:813-994-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH259123336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135104OtherPK
FL00581990Medicaid