Provider Demographics
NPI:1528399474
Name:DJ PHARMACY LLC
Entity Type:Organization
Organization Name:DJ PHARMACY LLC
Other - Org Name:DJ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOTADE
Authorized Official - Middle Name:
Authorized Official - Last Name:IKUDAYISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-495-2234
Mailing Address - Street 1:20122 SHADY HILL LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3396
Mailing Address - Country:US
Mailing Address - Phone:813-495-2234
Mailing Address - Fax:
Practice Address - Street 1:5622 MARINE PKWY STE 23
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4335
Practice Address - Country:US
Practice Address - Phone:727-232-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH243933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1052632OtherNCPDP PROVIDER IDENTIFICATION NUMBER