Provider Demographics
NPI:1154429181
Name:ROYAL RX PHARMACY INC
Entity type:Organization
Organization Name:ROYAL RX PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAENEISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-980-6334
Mailing Address - Street 1:4941 E BUSCH BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6056
Mailing Address - Country:US
Mailing Address - Phone:813-980-6334
Mailing Address - Fax:813-980-6338
Practice Address - Street 1:4941 E BUSCH BLVD
Practice Address - Street 2:STE 240
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-6056
Practice Address - Country:US
Practice Address - Phone:813-980-6334
Practice Address - Fax:813-980-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
FLPH200463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2008586OtherPK
FL026883600Medicaid
5313610001Medicare NSC