Provider Demographics
NPI:1376217091
Name:ALEX, REJI (RPH)
Entity Type:Individual
Prefix:MR
First Name:REJI
Middle Name:
Last Name:ALEX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 W WATERS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1972
Mailing Address - Country:US
Mailing Address - Phone:813-374-0395
Mailing Address - Fax:813-605-5860
Practice Address - Street 1:4202 W WATERS AVE STE 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1972
Practice Address - Country:US
Practice Address - Phone:813-374-0395
Practice Address - Fax:813-605-5860
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist