Provider Demographics
NPI:1962782326
Name:FAVOURITE PHARMACY INC
Entity type:Organization
Organization Name:FAVOURITE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-443-4635
Mailing Address - Street 1:1405 TAMPA PARK PLAZA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-4821
Mailing Address - Country:US
Mailing Address - Phone:813-443-4635
Mailing Address - Fax:813-443-4636
Practice Address - Street 1:1405 TAMPA PARK PLAZA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-4821
Practice Address - Country:US
Practice Address - Phone:813-443-5565
Practice Address - Fax:813-443-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH256063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5707306OtherNCPDP PROVIDER IDENTIFICATION NUMBER