Provider Demographics
NPI:1174684757
Name:HEPZIBAH INC
Entity Type:Organization
Organization Name:HEPZIBAH INC
Other - Org Name:KAY PHARMACY #001
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUKAYODE
Authorized Official - Middle Name:THEOPHILUS
Authorized Official - Last Name:OGUNDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-632-9032
Mailing Address - Street 1:3500 E FLETCHER AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4789
Mailing Address - Country:US
Mailing Address - Phone:813-632-9032
Mailing Address - Fax:813-632-9035
Practice Address - Street 1:3500 E FLETCHER AVE STE 120
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4789
Practice Address - Country:US
Practice Address - Phone:813-632-9032
Practice Address - Fax:813-632-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH197173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy