Active NPI
H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.
- Clinic Pharmacy
- Tampa, FL
National Provider Identifier
1841393907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic Pharmacy
- License
- PH9513
- Legal business name
- H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC.
- Practice address
- 12902 Usf Magnolia Dr
Tampa, FL 33612-9416 - Phone
- (813) 745-7354
- Fax
- (813) 745-1484
- NPI assigned
- Sep 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sophia Alfonso
- Title
- Pharmacy MGR
- Phone
- (813) 745-7354
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Clinic Pharmacy | 3336C0002X | PH9513 | FL | Primary |
| Community/Retail Pharmacy | 3336C0003X | |||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
12902 Usf Magnolia Dr
Tampa, FL 33612-9416
Mailing address
12902 Usf Magnolia Dr
Mailstop: MCC-Pharm
Tampa, FL 33612-9416
Phone (813) 745-7354
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109430100 | Medicaid | FL | |
| 2007989 | Other | PK |
Other names 1
- CLINIC PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110627000803 | FL | DME Supplier - Pharmacy | 0547217994 | Practice locations: Tampa, FL |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Special Hospital
- Tampa, FL
- NPI 1780653618
0547217994
National Provider Directory
National Provider Directory- Tax ID family
- H Lee Moffitt Cancer CT
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Chronic Disease Hospital
- Tampa, FL
- NPI 1790122380
-
- Specialty Pharmacy
- Tampa, FL
- NPI 1023756475
-
- Durable Medical Equipment & Medical Supplies
- Tampa, FL
- NPI 1073339412
-
- Special Hospital
- Tampa, FL
- NPI 1780653618
Locations
2709 E College Ave
Ruskin, FL 33570
4101 Jim Walter Blvd
#H
Tampa, FL 33607
10901 McKinley Dr
Tampa, FL 33612
Phone (813) 745-3000
2590 Healing Way
Ste 200
Wesley Chapel, FL 33543
Phone (813) 745-7888
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- St Petersburg, FL
- NPI 1730179896
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598313600000",
"number": "1841393907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12902 USF MAGNOLIA DR",
"address_2": "MAILSTOP: MCC-PHARM",
"city": "TAMPA",
"state": "FL",
"postal_code": "336129416",
"telephone_number": "813-745-7354",
"fax_number": "813-745-1484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12902 USF MAGNOLIA DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336129416",
"telephone_number": "813-745-7354",
"fax_number": "813-745-1484"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-06",
"last_updated": "2020-08-25",
"certification_date": "2020-08-25",
"status": "A",
"authorized_official_last_name": "ALFONSO",
"authorized_official_first_name": "SOPHIA",
"authorized_official_title_or_position": "PHARMACY MGR",
"authorized_official_telephone_number": "813-745-7354"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": "FL",
"license": "PH9513",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109430100",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2007989",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CLINIC PHARMACY",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CLINIC PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tampa, FL
- H. Lee Moffitt Cancer Center & Research Institute
- H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc
- H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.
- H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.
- H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.
- H2 Medical Corp
- H3Art 2 Hearts LLC
- Alexander Maxwell Haas, M.D.
- Jennifer Joan Haas, ARNP
- Matthew Haas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.