Provider Demographics
NPI:1417588625
Name:MULBERRY FOOD AND PHARMACY LLC
Entity Type:Organization
Organization Name:MULBERRY FOOD AND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GISHA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-770-1394
Mailing Address - Street 1:17604 OLD OAK WAY
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5026
Mailing Address - Country:US
Mailing Address - Phone:813-770-1394
Mailing Address - Fax:
Practice Address - Street 1:806 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-2036
Practice Address - Country:US
Practice Address - Phone:813-770-1394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy