Provider Demographics
NPI:1619032042
Name:FLETCHER DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:FLETCHER DISCOUNT PHARMACY INC
Other - Org Name:NEXT DOSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-977-2013
Mailing Address - Street 1:3450 E FLETCHER AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4655
Mailing Address - Country:US
Mailing Address - Phone:813-977-2013
Mailing Address - Fax:813-441-7255
Practice Address - Street 1:3450 E FLETCHER AVE
Practice Address - Street 2:STE 140
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4655
Practice Address - Country:US
Practice Address - Phone:813-977-2013
Practice Address - Fax:813-441-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH223863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031837000Medicaid
1023833OtherNCPDP PROVIDER IDENTIFICATION NUMBER