Provider Demographics
NPI:1831499557
Name:QUADREN LLC
Entity Type:Organization
Organization Name:QUADREN LLC
Other - Org Name:BOOTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAJUDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-480-9223
Mailing Address - Street 1:8001 N DALE MABRY HWY
Mailing Address - Street 2:BUILDING 801 SUITE #A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3290
Mailing Address - Country:US
Mailing Address - Phone:813-935-4936
Mailing Address - Fax:813-935-4938
Practice Address - Street 1:8001 N DALE MABRY HWY
Practice Address - Street 2:BUILDING 801 SUITE #A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3290
Practice Address - Country:US
Practice Address - Phone:813-935-4936
Practice Address - Fax:813-935-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH242583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5702229OtherNCPDP PROVIDER IDENTIFICATION NUMBER