Provider Demographics
NPI:1912436775
Name:TAMPA SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:TAMPA SPECIALTY PHARMACY LLC
Other - Org Name:TAMPA SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-304-2221
Mailing Address - Street 1:5908 BRECKENRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4233
Mailing Address - Country:US
Mailing Address - Phone:813-644-7277
Mailing Address - Fax:813-875-4000
Practice Address - Street 1:5908 BRECKENRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4233
Practice Address - Country:US
Practice Address - Phone:813-644-7277
Practice Address - Fax:813-875-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH29926333600000X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169496OtherPK