Provider Demographics
NPI:1982900981
Name:COMMUNITY SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:COMMUNITY SPECIALTY PHARMACY LLC
Other - Org Name:COMMUNITY SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:727-896-0001
Mailing Address - Street 1:6308 BENJAMIN RD STE 709
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5174
Mailing Address - Country:US
Mailing Address - Phone:727-896-0001
Mailing Address - Fax:727-896-0002
Practice Address - Street 1:6308 BENJAMIN RD STE 709
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5174
Practice Address - Country:US
Practice Address - Phone:727-896-0001
Practice Address - Fax:727-896-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRXADE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-08
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
FLPH252263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101243700Medicaid
FL25226OtherFLBOP
FL25226OtherFLBOP