NPIMap

Organization Active NPI

Hepzibah Inc

  • Community/Retail Pharmacy
  • Thonotosassa, FL
National Provider Identifier
1578715215
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH23546 Issued in FL
Legal business name
HEPZIBAH INC
Practice address
10802 Main St
Ste a
Thonotosassa, FL 33592-2840
Phone
(813) 413-8242
Fax
(813) 413-8302
NPI assigned
Oct 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jack Diamond
Title
Owner, VP, Ao
Phone
(813) 484-8611

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PH23546 FL Primary

Addresses

Primary practice location

10802 Main St
Ste a
Thonotosassa, FL 33592-2840

Mailing address

3500 E Fletcher Ave
Tampa, FL 33613-4708
Phone (813) 413-8242

Other identifiers 2

IdentifierTypeStateIssuer
001349300MedicaidFL
2117414OtherPK

Other names 1

  • SRX Pharmacy #002 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hepzibah Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3500 E Fletcher Ave
Tampa, FL 33613
Phone (813) 210-0991

10802 Main St
Ste A
Thonotosassa, FL 33592
Phone (813) 413-8242

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1578715215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 E FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134708",
            "telephone_number": "813-413-8242",
            "fax_number": "813-413-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 MAIN ST",
            "address_2": "STE A",
            "city": "THONOTOSASSA",
            "state": "FL",
            "postal_code": "335922840",
            "telephone_number": "813-413-8242",
            "fax_number": "813-413-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEPZIBAH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER, VP, AO",
        "authorized_official_telephone_number": "813-484-8611"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH23546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001349300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117414",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRX Pharmacy #002",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thonotosassa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.