Provider Demographics
NPI:1487818340
Name:PHEMMY VENTURES INC
Entity Type:Organization
Organization Name:PHEMMY VENTURES INC
Other - Org Name:HEALTHMART DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VENAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NANAKUMO
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM
Authorized Official - Phone:813-843-3224
Mailing Address - Street 1:1412 W WATERS AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2802
Mailing Address - Country:US
Mailing Address - Phone:813-931-3700
Mailing Address - Fax:813-931-3747
Practice Address - Street 1:1412 W WATERS AVE STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2802
Practice Address - Country:US
Practice Address - Phone:813-931-3700
Practice Address - Fax:813-931-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH231883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1036121OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL000027500Medicaid