Provider Demographics
NPI:1629410469
Name:SUPERIOR PHARMACY OF TEMPLE TERRACE, LLC
Entity Type:Organization
Organization Name:SUPERIOR PHARMACY OF TEMPLE TERRACE, LLC
Other - Org Name:TEMPLE TERRACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-989-1351
Mailing Address - Street 1:5671 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2307
Mailing Address - Country:US
Mailing Address - Phone:813-989-1351
Mailing Address - Fax:
Practice Address - Street 1:5671 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2307
Practice Address - Country:US
Practice Address - Phone:813-989-1351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRANA ASSETS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH20915333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy