Provider Demographics
NPI:1457741696
Name:HM BLOOMINGDALE LLC
Entity type:Organization
Organization Name:HM BLOOMINGDALE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUNZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-689-2273
Mailing Address - Street 1:805 E BLOOMINGDALE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8113
Mailing Address - Country:US
Mailing Address - Phone:813-689-2273
Mailing Address - Fax:813-689-8200
Practice Address - Street 1:3535 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8405
Practice Address - Country:US
Practice Address - Phone:813-689-2273
Practice Address - Fax:813-689-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH288453336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017428900Medicaid