Provider Demographics
NPI:1619534997
Name:ULTIMATE PHARMACY LLC
Entity Type:Organization
Organization Name:ULTIMATE PHARMACY LLC
Other - Org Name:ULTIMATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:352-592-6340
Mailing Address - Street 1:1250 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5657
Mailing Address - Country:US
Mailing Address - Phone:352-592-6340
Mailing Address - Fax:352-592-6345
Practice Address - Street 1:1250 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5657
Practice Address - Country:US
Practice Address - Phone:352-592-6340
Practice Address - Fax:352-592-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy