Provider Demographics
NPI:1457726150
Name:PHARMAX SPECIALTY PHARMACY INC
Entity Type:Organization
Organization Name:PHARMAX SPECIALTY PHARMACY INC
Other - Org Name:CLRX PHARMACY TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-880-2500
Mailing Address - Street 1:7808 WOODLAND CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2409
Mailing Address - Country:US
Mailing Address - Phone:813-880-2500
Mailing Address - Fax:813-880-2501
Practice Address - Street 1:7808 WOODLAND CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2409
Practice Address - Country:US
Practice Address - Phone:813-880-2500
Practice Address - Fax:813-880-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH294653336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH29465OtherPHARMACY
FL109906700Medicaid