Provider Demographics
NPI:1992710503
Name:JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA
Entity type:Organization
Organization Name:JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:SCHULHOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-898-7451
Mailing Address - Street 1:12220 BRUCE B DOWNS BLVD
Mailing Address - Street 2:DEPT# 6500101608
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9201
Mailing Address - Country:US
Mailing Address - Phone:813-631-5006
Mailing Address - Fax:813-631-5094
Practice Address - Street 1:12220 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9201
Practice Address - Country:US
Practice Address - Phone:813-631-5006
Practice Address - Fax:813-631-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH138373336C0003X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103700500Medicaid
FL103700501Medicaid
2009761OtherPK