Provider Demographics
NPI:1265730345
Name:MIDTOWN APOTHECARY INC.
Entity type:Organization
Organization Name:MIDTOWN APOTHECARY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALE
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-536-7291
Mailing Address - Street 1:2136 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6512
Mailing Address - Country:US
Mailing Address - Phone:813-527-0765
Mailing Address - Fax:813-644-6992
Practice Address - Street 1:2136 W MLK BLVD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6512
Practice Address - Country:US
Practice Address - Phone:813-527-0765
Practice Address - Fax:813-644-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH257113336C0002X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021834500Medicaid
FL6672090001Medicare NSC