Provider Demographics
NPI:1467640367
Name:TOWER PHARMACY AND MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:TOWER PHARMACY AND MEDICAL SUPPLY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHCY MANG
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENACQUAAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-493-2316
Mailing Address - Street 1:2727 WEST DR MARTIN L KING
Mailing Address - Street 2:STE 220
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 WEST DR MARTIN L KING
Practice Address - Street 2:STE 220
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-870-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH228723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032403500Medicaid
1029102OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6092830001Medicare NSC