Provider Demographics
NPI:1801347190
Name:SEFFNER HEALTH PHARMACY LLC
Entity type:Organization
Organization Name:SEFFNER HEALTH PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-405-8900
Mailing Address - Street 1:10907 E US HIGHWAY 92 STE D
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3231
Mailing Address - Country:US
Mailing Address - Phone:813-405-8900
Mailing Address - Fax:813-614-9133
Practice Address - Street 1:10907 E US HIGHWAY 92 STE D
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3231
Practice Address - Country:US
Practice Address - Phone:813-405-8900
Practice Address - Fax:813-614-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X
FLPH30419333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165942OtherPK