Provider Demographics
NPI:1972903086
Name:MEDICATION HEALTH CENTER LLC
Entity Type:Organization
Organization Name:MEDICATION HEALTH CENTER LLC
Other - Org Name:MEDICATION HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IBUKUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETULA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-360-0528
Mailing Address - Street 1:150 E BLOOMINGDALE AVE
Mailing Address - Street 2:SUITE 164
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8151
Mailing Address - Country:US
Mailing Address - Phone:813-360-0528
Mailing Address - Fax:855-771-3086
Practice Address - Street 1:150 E BLOOMINGDALE AVE
Practice Address - Street 2:SUITE 164
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8151
Practice Address - Country:US
Practice Address - Phone:813-360-0528
Practice Address - Fax:855-771-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty