Provider Demographics
NPI:1649798356
Name:KABS OF TAMPA INC
Entity type:Organization
Organization Name:KABS OF TAMPA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOLAWOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-988-4000
Mailing Address - Street 1:2812 E BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2653
Mailing Address - Country:US
Mailing Address - Phone:813-843-0224
Mailing Address - Fax:
Practice Address - Street 1:2812 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2653
Practice Address - Country:US
Practice Address - Phone:813-843-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KABS OF TAMPA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH180883336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025271900Medicaid