Provider Demographics
NPI:1972896314
Name:VETERANS PHARMACY INC
Entity Type:Organization
Organization Name:VETERANS PHARMACY INC
Other - Org Name:VETERANS PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:UBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-964-6881
Mailing Address - Street 1:PO BOX 16722
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-6722
Mailing Address - Country:US
Mailing Address - Phone:813-964-6881
Mailing Address - Fax:813-964-6890
Practice Address - Street 1:11434 N 53RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2216
Practice Address - Country:US
Practice Address - Phone:813-964-6881
Practice Address - Fax:813-964-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH254623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130215OtherPK
FL003899000Medicaid
7318450001Medicare NSC