Provider Demographics
NPI:1205029279
Name:TORI INC
Entity Type:Organization
Organization Name:TORI INC
Other - Org Name:LAKELAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EZEKIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ONYEBUEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-839-2193
Mailing Address - Street 1:3405 S DALE MABRY HWY STE D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8601
Mailing Address - Country:US
Mailing Address - Phone:813-839-2193
Mailing Address - Fax:813-839-2196
Practice Address - Street 1:3405 S DALE MABRY HWY STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8601
Practice Address - Country:US
Practice Address - Phone:813-839-2193
Practice Address - Fax:813-839-2196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TORI INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22722333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032081100Medicaid