Provider Demographics
NPI:1427562412
Name:ZEPHYRHILLS PHARMACY LLC
Entity Type:Organization
Organization Name:ZEPHYRHILLS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHAGAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-815-7000
Mailing Address - Street 1:36600 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-6940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36600 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:813-220-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH310463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024126900Medicaid
FLPH31046OtherFLORIDA BOARD OF PHARMACY