Provider Demographics
NPI:1225108087
Name:FLORIDA MEDICAL CLINIC LLC PHARMACY
Entity Type:Organization
Organization Name:FLORIDA MEDICAL CLINIC LLC PHARMACY
Other - Org Name:FLORIDA MEDICAL CLINIC LLC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-715-0354
Mailing Address - Street 1:38045 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7504
Mailing Address - Country:US
Mailing Address - Phone:813-715-0354
Mailing Address - Fax:813-779-8049
Practice Address - Street 1:38045 MARKET SQ
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7504
Practice Address - Country:US
Practice Address - Phone:813-715-0354
Practice Address - Fax:813-779-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15559332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1081330OtherNABP
FL106207700Medicaid