Provider Demographics
NPI:1942652110
Name:OXFORD PHARMACY LLC
Entity Type:Organization
Organization Name:OXFORD PHARMACY LLC
Other - Org Name:OXFORD PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAHDRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-371-6174
Mailing Address - Street 1:20205 AUTUMN FERN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2915
Mailing Address - Country:US
Mailing Address - Phone:561-371-6174
Mailing Address - Fax:727-378-4915
Practice Address - Street 1:12134 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2058
Practice Address - Country:US
Practice Address - Phone:727-378-4615
Practice Address - Fax:727-378-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH30166333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162214OtherPK