Provider Demographics
NPI:1548558463
Name:CBA PHARMACY INC
Entity Type:Organization
Organization Name:CBA PHARMACY INC
Other - Org Name:GOOD HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHIRANJEEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-933-5830
Mailing Address - Street 1:1911 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6509
Mailing Address - Country:US
Mailing Address - Phone:813-933-5830
Mailing Address - Fax:813-933-5841
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 103&102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-933-5830
Practice Address - Fax:813-933-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH256803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132399OtherPK