Provider Demographics
NPI:1811187198
Name:WATERS COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:WATERS COMMUNITY PHARMACY
Other - Org Name:WATERS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-541-5490
Mailing Address - Street 1:8206 W WATERS AVE
Mailing Address - Street 2:STE 114
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8206 W WATERS AVE
Practice Address - Street 2:STE 114
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1852
Practice Address - Country:US
Practice Address - Phone:813-888-9900
Practice Address - Fax:813-888-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH228343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027817OtherOTHER ID NUMBER