Provider Demographics
NPI:1982906046
Name:SUPERIOR PHARMACY OF TEMPLE TERRACE
Entity Type:Organization
Organization Name:SUPERIOR PHARMACY OF TEMPLE TERRACE
Other - Org Name:SUPERIOR PHARMACY OF TEMPLE TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-368-2746
Mailing Address - Street 1:11521 N. 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-989-1351
Mailing Address - Fax:813-988-4795
Practice Address - Street 1:11521 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2238
Practice Address - Country:US
Practice Address - Phone:813-989-1351
Practice Address - Fax:813-988-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH249083336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5702685OtherNCPDP PROVIDER IDENTIFICATION NUMBER