Provider Demographics
NPI:1518252170
Name:MOBLEY, MICHAEL CLAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLAY
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2739
Mailing Address - Country:US
Mailing Address - Phone:813-264-7158
Mailing Address - Fax:813-279-6264
Practice Address - Street 1:11661 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2739
Practice Address - Country:US
Practice Address - Phone:813-264-7158
Practice Address - Fax:813-279-6264
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist