Provider Demographics
NPI:1972773984
Name:HOLIDAY PHARMACY INC
Entity Type:Organization
Organization Name:HOLIDAY PHARMACY INC
Other - Org Name:TAMPABAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-933-6900
Mailing Address - Street 1:6751 N ARMENIA AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5701
Mailing Address - Country:US
Mailing Address - Phone:813-933-6900
Mailing Address - Fax:813-933-0800
Practice Address - Street 1:6751 N ARMENIA AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5701
Practice Address - Country:US
Practice Address - Phone:813-933-6900
Practice Address - Fax:813-933-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH232323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032630500Medicaid