Provider Demographics
NPI:1790141570
Name:PHARMACORE RX LLC
Entity Type:Organization
Organization Name:PHARMACORE RX LLC
Other - Org Name:PHARMACORE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-580-8040
Mailing Address - Street 1:5406 HOOVER BLVD STE 19
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5330
Mailing Address - Country:US
Mailing Address - Phone:813-580-8040
Mailing Address - Fax:813-580-8041
Practice Address - Street 1:13930 LYNMAR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3123
Practice Address - Country:US
Practice Address - Phone:813-580-8040
Practice Address - Fax:813-580-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH297393336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016885600Medicaid
2157794OtherPK