Provider Demographics
NPI:1285895250
Name:EZ RX PHARMACY LLC
Entity type:Organization
Organization Name:EZ RX PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-960-2020
Mailing Address - Street 1:PO BOX 340869
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694-0869
Mailing Address - Country:US
Mailing Address - Phone:813-960-2020
Mailing Address - Fax:813-960-2044
Practice Address - Street 1:6916 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5815
Practice Address - Country:US
Practice Address - Phone:813-960-2020
Practice Address - Fax:813-960-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
FLPH234943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1036486OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1036486OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL6293670001Medicare NSC