Provider Demographics
NPI:1215335948
Name:TAMPA ROAD PHARMACY
Entity type:Organization
Organization Name:TAMPA ROAD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:347-816-2198
Mailing Address - Street 1:2488 JOHNNA CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2031
Mailing Address - Country:US
Mailing Address - Phone:347-816-2198
Mailing Address - Fax:
Practice Address - Street 1:3705 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6300
Practice Address - Country:US
Practice Address - Phone:347-816-2198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty