Provider Demographics
NPI:1518153634
Name:MADABHUSHI PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MADABHUSHI PHARMACY SERVICES LLC
Other - Org Name:MEDICINE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADABHUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-961-6546
Mailing Address - Street 1:14936 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1626
Mailing Address - Country:US
Mailing Address - Phone:813-961-6546
Mailing Address - Fax:813-963-6379
Practice Address - Street 1:14936 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1626
Practice Address - Country:US
Practice Address - Phone:813-961-6546
Practice Address - Fax:813-963-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPS358463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1028845OtherNCPDP #
FL0323349 00Medicaid
FLFM0698956OtherDEA
FLFM0698956OtherDEA
FLAI987AMedicare PIN