Provider Demographics
NPI:1962817734
Name:CIMINO, BERNARD JR (RPH)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:CIMINO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2408
Mailing Address - Country:US
Mailing Address - Phone:813-870-1476
Mailing Address - Fax:813-871-2031
Practice Address - Street 1:2525 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2408
Practice Address - Country:US
Practice Address - Phone:813-870-1476
Practice Address - Fax:813-871-2031
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS13941OtherSTATE LICENSE #