Provider Demographics
NPI:1437328986
Name:KABS OF BRANDON INC
Entity type:Organization
Organization Name:KABS OF BRANDON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-200-8059
Mailing Address - Street 1:759 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4901
Mailing Address - Country:US
Mailing Address - Phone:813-413-8362
Mailing Address - Fax:813-413-8370
Practice Address - Street 1:759 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4901
Practice Address - Country:US
Practice Address - Phone:813-413-8362
Practice Address - Fax:813-413-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH231793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010760OtherPK
FL000608700Medicaid