Provider Demographics
NPI:1235544594
Name:UNIVERSITY OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH FLORIDA
Other - Org Name:USF HEALTH PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:GENDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-974-0133
Mailing Address - Street 1:13330 USF LAUREL DR.
Mailing Address - Street 2:MDC 52
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-974-0133
Mailing Address - Fax:813-905-9947
Practice Address - Street 1:13330 USF LAUREL DR.
Practice Address - Street 2:MDC 52
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-974-0133
Practice Address - Fax:813-905-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH282263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012980300Medicaid