Provider Demographics
NPI:1134400823
Name:TAMPA FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:TAMPA FAMILY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HANSIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KALARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-871-5161
Mailing Address - Street 1:12470 TELECOM DR STE 110W
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0904
Mailing Address - Country:US
Mailing Address - Phone:813-871-5161
Mailing Address - Fax:813-877-2479
Practice Address - Street 1:12470 TELECOM DR STE 110W
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0904
Practice Address - Country:US
Practice Address - Phone:813-871-5161
Practice Address - Fax:813-877-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X, 333600000X, 3336C0004X
FLPH256243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101148800Medicaid
2131723OtherPK