Provider Demographics
NPI:1750772612
Name:RX FLORIDA PHARMACY LLC
Entity type:Organization
Organization Name:RX FLORIDA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOPE
Authorized Official - Middle Name:KASSIM
Authorized Official - Last Name:MABIFA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:407-704-6422
Mailing Address - Street 1:46 HERRINGBONE WAY ORMOND BEACH. FL 32174
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:678-559-6734
Mailing Address - Fax:407-704-6322
Practice Address - Street 1:3615 COLUMBIA STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-704-6422
Practice Address - Fax:407-704-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28826183500000X, 3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014580000Medicaid