Active NPI
Kenneth O Shobola, R. PH.
- Pharmacist
- Tampa, FL
National Provider Identifier
1821122482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS 29682
- Practice address
- 4730 N Habana Ave
Suite 101
Tampa, FL 33614-7163 - Phone
- (813) 348-0095
- NPI assigned
- Mar 15, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS 29682 | FL | Primary |
Addresses
Primary practice location
4730 N Habana Ave
Suite 101
Tampa, FL 33614-7163
Mailing address
PO Box 15779
Tampa, FL 33684-5779
Phone (813) 426-5419
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS29682 | Other | FL | BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS 29682 | FL | MD | Pharmacist |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Pinehills Discount Pharmacy
- Community/Retail Pharmacy
- Orlando, FL
- NPI 1205957636
-
dba Ken Drugs Pine Hills Discount Pharmacy
- Community/Retail Pharmacy
- Orlando, FL
- NPI 1265583272
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821122482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15779",
"city": "TAMPA",
"state": "FL",
"postal_code": "336845779",
"telephone_number": "813-426-5419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4730 N HABANA AVE",
"address_2": "SUITE 101",
"city": "TAMPA",
"state": "FL",
"postal_code": "336147163",
"telephone_number": "813-348-0095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOBOLA",
"first_name": "KENNETH",
"middle_name": "O",
"name_prefix": "Mr.",
"credential": "R. PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS 29682",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMACY",
"identifier": "PS29682",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.